Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2020 Dec;32(6):1027-1033. doi: 10.1111/1742-6723.13606. Epub 2020 Aug 29.
To determine if COVID-19 State of Emergency (SOE) restrictions were associated with a reduction in presentations to two urban EDs in Melbourne, Victoria.
This retrospective observational study included adult patients presenting to The Alfred and Sandringham Hospital EDs during the first month of stage 2 and 3 SOE restrictions (26 March-25 April 2020). Patients transferred from other hospitals or diagnosed with COVID-19 were excluded. The primary outcome was the average number of presentations per day. Secondary outcomes included the average daily number of presentations for pre-specified subgroups defined by triage category and diagnosis. The independent impact of SOE restrictions, adjusted for underlying trends in attendance, was determined using negative binomial regression and reported as an incident rate ratio (IRR) with a 95% confidence interval (CI).
Average daily attendance during the exposure period was 174.7. In the absence of SOE restrictions, 278.8 presentations per day were predicted, a reduction of 37.3% (IRR 0.63, 95% CI 0.59-0.67). Attendance was lower than anticipated for all triage categories (especially category 5 [IRR 0.51, 95% CI 0.44-0.59]) and diagnostic groups (including circulatory problems [IRR 0.62, 95% CI 0.50-0.76] and injury [IRR 0.58, 95% CI 0.53-0.63]). There were fewer than predicted presentations for several sentinel diagnoses, including gastroenteritis (IRR 0.27, 95% CI 0.17-0.42) and renal colic (IRR 0.55, 95% CI 0.33-0.92).
SOE restrictions were associated with a significant reduction in ED presentations across a range of triage categories and diagnoses. Public health messaging should emphasise the importance of timely ED attendance for acute illness and injury.
确定 COVID-19 紧急状态 (SOE) 限制是否与维多利亚州墨尔本两家城市急诊部就诊人数减少有关。
本回顾性观察研究纳入了 2020 年 3 月 26 日至 4 月 25 日 SOE 限制的第 2 阶段和第 3 阶段期间，在阿尔弗雷德医院和桑德灵厄姆医院急诊部就诊的成年患者。排除从其他医院转来或诊断为 COVID-19 的患者。主要结局为每日就诊人数的平均值。次要结局包括按分诊类别和诊断预先指定的亚组的每日平均就诊人数。使用负二项回归确定 SOE 限制的独立影响，调整就诊的潜在趋势，并以发病率比 (IRR) 及其 95%置信区间 (CI) 报告。
暴露期内每日平均就诊人数为 174.7 人。如果没有 SOE 限制，预计每天会有 278.8 次就诊，减少 37.3%（IRR 0.63，95%CI 0.59-0.67）。所有分诊类别（尤其是 5 类[IRR 0.51，95%CI 0.44-0.59]）和诊断组（包括循环问题[IRR 0.62，95%CI 0.50-0.76]和损伤[IRR 0.58，95%CI 0.53-0.63]）的就诊人数均低于预期。一些警戒性诊断的就诊人数也低于预期，包括肠胃炎（IRR 0.27，95%CI 0.17-0.42）和肾绞痛（IRR 0.55，95%CI 0.33-0.92）。
SOE 限制与一系列分诊类别和诊断的急诊就诊人数显著减少有关。公共卫生宣传应强调及时就诊急性疾病和损伤的重要性。
