Non-COVID-19 patients in times of pandemic: Emergency department visits, hospitalizations and cause-specific mortality in Northern Italy

  1. Luca Santi
  2. Davide Golinelli
  3. Andrea Tampieri
  4. Gabriele Farina
  5. Manfredi Greco
  6. Simona Rosa
  7. Michelle Beleffi
  8. Bianca Biavati
  9. Francesca Campinoti
  10. Stefania Guerrini
  11. Rodolfo Ferrari
  12. Paola Rucci
  13. Maria Pia Fantini
  14. Fabrizio Giostra

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

The COVID-19 pandemic forced healthcare services organization to adjust to mutating healthcare needs. Not exhaustive data are available on the consequences of this on non-COVID-19 patients. The aim of this study was to assess the impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants’ area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of Emergency Department (ED) visits, hospitalizations and mortality. We conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1 st , 2019 to May 31 st , 2020, were compared with those of the same period of the previous year. Non-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case of COVID-19 has been recorded, on February 19 th , 2020, when they dropped simultaneously. The reduction of ED visits was observed in all age groups and across all severity and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43.2%) and cause-specific out-of-hospital mortality related to neoplasms (76.7%), endocrine, nutritional and metabolic (79.5%) as well as cardiovascular (32.7%) diseases. The pandemic caused a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the lockdown period, and a concurrent increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases. As recurrencies of the COVID-19 pandemic are underway, the scenario described in this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it.

Article activity feed

  1. Version published to 10.1371/journal.pone.0248995
  2. ScreenIT

    SciScore for 10.1101/2020.11.10.20229237: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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: This study has some limitations. First, mortality data might include under-diagnosed COVID-19 cases. In fact the type of access and causes of death could have been coded incorrectly. However this is unavoidable due to the case definition and the context of that time-period, when the pandemic disruptively changed routine practice. Furthermore, considering the delayed onset of the pandemic in BMA and the preparedness efforts of local healthcare authorities, compared to other Italian areas earlier affected, we assume that no significant underestimation of COVID-19 deaths occurred, and that just a minority of COVID-19 deaths occurred out of the hospital, given that the vast majority of severely symptomatic COVID-19 patients had been hospitalized. Furthermore, we had access to cause-specific mortality data, but only aggregated into broad categories (e.g. death for cardiovascular diseases, death for injury or poisoning, etc.). Data on more specific causes of death are still not available and therefore no conclusions can be drawn on more specific causes of death. Finally, the short time window of the post-lockdown period considered in this study does not allow us to generalize our findings regarding possible medium and long term effects of the pandemic. Additional data are necessary to understand the effects of diagnostic and therapeutic delays that the pandemic has inevitably entailed, both for chronic and for acute patients.

    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.

    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.

  3. Version published to 10.1101/2020.11.10.20229237v1 on medRxiv
  4. Version published to 10.1101/2020.11.10.20229237v2 on medRxiv