Barriers to seeking emergency care during the COVID-19 pandemic may lead to higher morbidity and mortality - a retrospective study from a Swiss university hospital - Hautz, W. E.; Sauter, T. C.; Exadakytlos, A. K.; Krummrey, G.; Schauber, S.; Muller, M. (Swiss Med Wkly, 2020)
AIMS OF THE STUDY: While COVID-19 significantly overburdens emergency rooms (ERs) and hospitals in affected areas, ERs elsewhere report a marked decrease in patient numbers. This study aimed to investigate the assumption that patients with urgent problems currently avoid the ER. METHODS: Electronic health records from the ER of a large Swiss university hospital were extracted for three periods: first, the awareness phase (ap) from the publication of the national government’s initiative “How to protect ourselves” on 1 March 2020 to the lockdown of the country on 16 March; second, the mitigation phase (mp) from 16–30 March; finally, patients presenting in March 2019 were used as a control group. We compared parameters including a critical illness as the discharge diagnosis (e.g., myocardial infarction, stroke, sepsis and ER death) using logistic and linear regression, as well as 15-day bootstrapped means and 95% confidence intervals for the control group. RESULTS: In the three periods, a total of 7143 patients were treated. We found a 24.9% (42.5%) significant decline in the number of patients presenting during the ap (mp). Patients presenting during the mp were more likely to be critically ill. There was an increase of 233% and 367% (ap and mp, respectively) of ER deaths (none related to COVID-19) compared with the control period. Apart from polytrauma (increase of 5% in the mp), all other critical illnesses as discharge diagnosis showed a lower incidence in descriptive analysis. Significantly more patients died in the ER in both the ap and mp. CONCLUSIONS: Barriers to seeking emergency care during COVID-19 pandemic may lead to higher morbidity and mortality. Healthcare authorities and hospitals must ensure low barriers to treatment and business as usual for all patients.
Keywords: journalArticle; Adult; Aged; Betacoronavirus; Coronavirus Infections/*epidemiology; Covid-19; Critical Illness/*epidemiology; Emergency Medical Services/*statistics & numerical data; Emergency Service, Hospital/statistics & numerical data; Female; Health Services Accessibility/*trends; Hospitals, University/statistics & numerical data; Humans; Incidence; Male; Middle Aged; Pandemics; Patient Acceptance of Health Care/*statistics & numerical data; Pneumonia, Viral/*epidemiology; Regression Analysis; Retrospective Studies; SARS-CoV-2; Switzerland/epidemiology