Emergency Department Utilization for Emergency Conditions During COVID-19 - 21/06/21
, Alexander T. Janke, MD a, Li Shu-Xia, PhD b, Craig Rothenberg, MPH a, Pawan Goyal, MD c, Aisha Terry, MD, MPH d, Michelle Lin, MD, MPH e
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Abstract |
Study objective |
We use a national emergency medicine clinical quality registry to describe recent trends in emergency department (ED) visitation overall and for select emergency conditions.
Methods |
Data were drawn from the Clinical Emergency Department Registry, including 164 ED sites across 35 states participating in the registry with complete data from January 2019 through November 15, 2020. Overall ED visit counts, as well as specific emergency medical conditions identified by International Classification of Diseases, Tenth Revision, Clinical Modification code (myocardial infarction, cerebrovascular accident, cardiac arrest/ventricular fibrillation, and venous thromboembolisms), were tabulated. We plotted biweekly visit counts overall and across specific geographic regions.
Results |
The largest declines in visit counts occurred early in the pandemic, with a nadir in April 46% lower than the 2019 monthly average. By November, overall ED visit counts had increased, but were 23% lower than prepandemic levels. The proportion of all ED visits that were for the select emergency conditions increased early in the pandemic; however, total visit counts for acute myocardial infarction and cerebrovascular disease have remained lower in 2020 compared with 2019. Despite considerable geographic and temporal variation in the trajectory of the coronavirus disease 2019 outbreak, the overall pattern of ED visits observed was similar across regions and time.
Conclusion |
The persistent decline in ED visits for these time-sensitive emergency conditions raises the concern that coronavirus disease 2019 may continue to impede patients from seeking essential care. Efforts thus far to encourage individuals with concerning signs and symptoms to seek emergency care may not have been sufficient.
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| Please see page 85 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: AKV and ATJ conceived the study. ATJ, CR, and SL designed and performed the analysis. AKV, PG, AT, and ML contributed to data acquisition. AKV and ATJ drafted the manuscript, and all authors contributed to the study. |
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| All authors attest to meeting the four 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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| Funding and support: 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. Dr. Venkatesh reports receiving support through contract HHSM-500-2013-13018I-T0001 modification 000002 from the Centers for Medicare & Medicaid Services, as well as receiving career development support (grant KL2TR001862) from the National Center for Advancing Translational Science and Yale Center for Clinical Investigation and the American Board of Emergency Medicine–National Academy of Medicine Anniversary Fellowship. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 78 - N° 1
P. 84-91 - juillet 2021 Regresar al número
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