Abstract
Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February –31 March) in the last three years (2018–2019–2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the recent and current pandemic, coronavirus disease 2019 (COVID-19)
We reviewed and compared clinical records of all the patients who were consecutively admitted to our emergency department (ED) over a 40-day period (21 February–31 March) in the last three years (2018–2019–2020)
Our data highlight that, during the analyzed time interval, ED admissions were mostly related to the COVID-19 disease or complications
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the recent and current pandemic, coronavirus disease 2019 (COVID-19). Everything seems to have started in late December. Given the estimates of reproduction for SARS-CoV-2, ranging from 2.24 to 3.58, the scientific community expressed immediate concern about a potential SARS-CoV-2 outbreak [4]. As of 22 January, 2020, a total of 571 cases of COVID-19 were observed in 25 provinces in China. Less than one month later, on 16 February, the number of COVID-19 cases reached 51,857 globally in 25 countries [4,5]. In Italy, the first case was registered on 21 February, 2020 [6]. People were not allowed to enter or exit this area starting from 1 March [8].
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