Emergency Department-Fondazione Policlinico Universitario A. Gemelli, IRCCS-Largo A. Gemelli, 00168 1 Rome, Italy.
Università Cattolica del Sacro Cuore-Largo F. Vito, 00168 1 Rome, Italy.
Medicina (Kaunas). 2020 Oct 1;56(10):512. doi: 10.3390/medicina56100512.
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 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. 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. 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.
急诊科常被患者视为解决所有医疗问题的可能途径，导致急诊科的误用率很高，可能导致过度拥挤。2019 年冠状病毒病（COVID-19）疫情始于中国；随后传播到意大利，意大利伦巴第大区于 2020 年 2 月首次确诊病例。这完全改变了被送往急诊科的患者类型。本研究旨在分析 COVID-19 大流行期间二级城市教学型（Fondazione Policlinico Universitario Agostino Gemelli IRCCS）急诊科入院人数的减少。
在这项回顾性观察性横断面研究中，我们回顾和比较了过去三年中（2018-2019-2020 年）在 40 天（2 月 21 日至 3 月 31 日）内连续收治我院急诊科的所有患者的临床记录。根据不同的医疗专业、住院和出院率，分析了平均年龄、性别、分诊紧急程度、白天/夜间入院、主要表现症状和最终诊断。
我们分析了 16281 例患者的临床记录。与 2019 年相比，2020 年急诊科入院人数总体减少 37.6%。2020 年，我们观察到急诊科入院分诊紧急程度增加（主要表现症状为发热）。我们注意到心胸、胃肠、泌尿、耳鼻喉/眼科和创伤疾病的入院人数明显下降。急性神经系统疾病仅略有下降，但具有统计学意义。肿瘤学入院人数稳定。2020 年传染病入院率为 30%，而 2018 年和 2019 年分别为 5%和 6%。2020 年，住院率上升至 42.9%，而前几年分别为 27.7%和 26.4%。
大流行期间急诊科入院人数的急剧减少可能与对病毒的恐惧有关，这表明患有严重疾病的患者没有去急诊室。此外，前一年可能存在急诊科的不当使用。特别是，心脏病学和神经病学入院人数下降令人担忧。由于担心感染 COVID-19，这些患者可能会推迟就医，从而导致不必要的发病率和死亡率。
