Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study - 19/01/22
, Janet Y.H. Wong, RN, PhD e, Xi Xiong, MSc c, Owen C.K. Chu, BSc a, Man S. Wong, PhD f, Matthew S.H. Tsui, MBBS, FHKAM b, Timothy H. Rainer, MD, FHKAM a, b
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Abstract |
Study objective |
We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong.
Methods |
We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality.
Results |
ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality.
Conclusion |
A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.
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| Please see page 149 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Kristin L. Rising, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: AW and CW contributed equally as cofirst authors. AW, JW, OC, and CW reviewed the literature, designed the statistical analysis, conducted analyses, and wrote the manuscript. AW, OC, and CW collected and compiled data. CW, JW, XX, MT, and TR provided critical input to the statistical analyses and design. AW acted as guarantor for the study. All authors contributed to the interpretation of the analysis, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. AW takes responsibility for the paper as a whole. |
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| Authorship: All authors attest to meeting the 4 ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Fundingandsupport: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. |
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Vol 79 - N° 2
P. 148-157 - février 2022 Retour au numéro
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