Abstract
IntroductionEmergency department (ED) attendances fell across the UK after the ‘lockdown’ introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19). We hypothesised that reductions would vary by patient age and disease type. We examined pre- and in-lockdown ED attendances for two COVID-19 unrelated diagnoses: one likely to be affected by lockdown measures (gastroenteritis), and one likely to be unaffected (appendicitis).MethodsWe conducted a retrospective cross-sectional study across two EDs in one London hospital Trust. We compared all adult and paediatric ED attendances, before (January 2020) and during lockdown (March/April 2020). Key patient demographics, method of arrival, and discharge location were compared. We used Systemised Nomenclature of Medicine codes to define attendances for gastroenteritis and appendicitis.ResultsED attendances fell from 1129 per day before lockdown to 584 in lockdown, 51.7% of pre-lockdown rates. In-lockdown attendances were lowest for under-18s (16.0% of pre-lockdown). The proportion of patients admitted to hospital increased from 17.3% to 24.0%, and the proportion admitted to intensive care increased fourfold. Attendances for gastroenteritis fell from 511 to 103, 20.2% of pre-lockdown rates. Attendances for appendicitis also decreased, from 144 to 41, 28.5% of pre-lockdown rates.ConclusionED attendances fell substantially following lockdown implementation. The biggest reduction was for under-18s. We observed reductions in attendances for gastroenteritis and appendicitis. This may reflect lower rates of infectious disease transmission, although the fall in appendicitis-related attendances suggests that behavioural factors were also important. Larger studies are urgently needed to understand changing patterns of ED use and access to emergency care during the coronavirus 2019 pandemic.
Highlights
Emergency department (ED) attendances fell across the UK after the ‘lockdown’ introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19)
We observed reductions in attendances for gastroenteritis and appendicitis. This may reflect lower rates of infectious disease transmission, the fall in appendicitis-related attendances suggests that behavioural factors were important
We compared ED attendances based on patient demographics, and we compared attendances for gastroenteritis and appendicitis, using the SNOMED-CT codes in Appendix 1 to define the study population, in total and by age, to assess examples of one diagnosis likely to be affected and one diagnosis unlikely to be affected by lockdown measures
Summary
Emergency department (ED) attendances fell across the UK after the ‘lockdown’ introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19). Changes in ED Activity and the First COVID-19 Lockdown likely to be multifactorial. The closure of schools and workplaces is likely to have led to a reduction in the spread of infectious diseases.[2] Reductions in organised sports and recreational activity have previously been linked to reductions in physical injuries.[3] It is suggested that reductions in children attending EDs reflect parents’ concerns about acquiring nosocomial COVID-19.4 Several authors have highlighted the potential for collateral damage from lockdowns, with patients deterred from seeking help for serious injuries and illnesses at risk of poorer outcomes.[5,6]
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