First and Second Wave Dynamics of Emergency Department Utilization during the COVID-19 Pandemic: a retrospective study

  1. Robi Dijk
  2. Patricia Plaum
  3. Stan Tummers
  4. Frits H.M. van Osch
  5. Dennis G. Barten
  6. Gideon H.P. Latten

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

Since the COVID-19 pandemic, there has been a decrease in emergency department(ED) utilization. Although this has been thoroughly characterized for the first wave(FW), studies during the second wave(SW) are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods.

Methods

We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March-June and September–December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non-)COVID-suspected.

Findings

During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID-related visits were significantly more often in higher need of urgent care and ARs where at least 24.0% higher compared to non-COVID visits.

Interpretation

During both COVID-19 waves ED visits were significantly reduced, with the most distinct decline during the FW. ED patients were more often triaged as high urgent and the ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. These findings indicate the need to gain more insight into motives of patients to delay or avoid emergency care during pandemics and prepare EDs for future pandemics.

Funding

None

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.12.09.21267520: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was approved by the medical ethical committee of Zuyderland Medical Center, Heerlen, the Netherlands (METCZ20210031).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    IBM SPSS Statistics for Macintosh, Version 27.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations include the retrospective nature of this study, prospective labeling may have been different between hospitals, the COVID waves continued past the end of our study period and 9,790 patients (17.3%) have been labeled retrospectively because there was no prospective labeling at the very beginning of the pandemic. Similar FW and SW dynamics were observed in all three EDs, based in a country with a well-developed primary care system and relatively low numbers of self-referrals. As a result, this study adds to the body of literature about ED utilization during the global COVID-19 pandemic. Future studies should focus on characteristics of the third and possible following waves of this ongoing pandemic. Furthermore, it would be desirable to gain more insight into motives of patients to delay or avoid emergency care.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.12.09.21267520v1 on medRxiv