Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine Kyungpook National University, Daegu, Republic of Korea.
National Emergency Medical Center, National Medical Center, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
Am J Emerg Med. 2021 Sep;47:35-41. doi: 10.1016/j.ajem.2021.03.038. Epub 2021 Mar 16.
During the early phase of the coronavirus disease 2019 (COVID-19) outbreak, many emergency departments (EDs) were exposed to COVID-19 and were temporarily closed according to national protocol of Korea. We aimed to evaluate the effect of concurrent and recurrent temporary closures of EDs on the clinical outcomes of patients who visited EDs during the COVID-19 outbreak.
This cross-sectional study used a nationwide emergency patient database. Patients who visited one of the 46 EDs in Daegu and Gyeongbuk between January 21 and April 14, 2020 were included. The main exposure variable was the first medical contact (ED visit or 119 call to emergency medical services (EMS)) during closure of at least one ED. There were 25 temporary closures of six Level-1 and Level-2 EDs between February 18 and March 17, 2020. We constructed a dataset by performing bidirectional crossover matching and conducted a conditional logistic regression analysis where the primary outcome was in-hospital mortality.
Of the 94,360 eligible study participants, 36,327 were classified into the non-EMS-use group and 10,116 were classified into the EMS-use group. In-hospital mortality rates were 2.0% and 1.6% for the temporary-closure and no-closure groups in the non-EMS-use group (p-value, 0.03) and 8.7% and 7.4% in the EMS-use group (p-value, 0.02), respectively. In the conditional logistic analysis for in-hospital mortality, the odds ratios (95% confidence intervals) of the temporary-closure group compared the no-closure group were 1.22 (1.03-1.44) among the non-EMS-use group and 1.23 (1.04-1.46) among the EMS-use group.
The temporary closures of EDs due to the unpredicted COVID-19 exposure resulted in an increase in emergency patients' in-hospital mortality rates irrespective of whether they used EMS. Preparing regional EMS systems to cope with new outbreaks is essential to protect the safety of all citizens.
在 2019 年冠状病毒病（COVID-19）爆发的早期阶段，许多急诊科（ED）暴露于 COVID-19，并根据韩国国家协议暂时关闭。我们旨在评估 COVID-19 爆发期间 ED 同时和反复临时关闭对急诊患者临床结局的影响。
这是一项使用全国性急诊患者数据库的横断面研究。将 2020 年 1 月 21 日至 4 月 14 日期间访问大邱和庆北 46 家 ED 之一的患者纳入研究。主要暴露变量是至少一家 ED 关闭期间的首次医疗接触（ED 就诊或 119 呼叫急救医疗服务（EMS））。2020 年 2 月 18 日至 3 月 17 日期间，有 6 家 1 级和 2 级 ED 进行了 25 次临时关闭。通过双向交叉匹配构建数据集，并进行条件逻辑回归分析，主要结局为院内死亡率。
在 94360 名合格的研究参与者中，36327 名被归入非 EMS 使用组，10116 名被归入 EMS 使用组。非 EMS 使用组中，临时关闭组和非关闭组的院内死亡率分别为 2.0%和 1.6%（p 值<0.03），EMS 使用组分别为 8.7%和 7.4%（p 值<0.02）。在院内死亡率的条件逻辑分析中，临时关闭组与非关闭组的比值比（95%置信区间）分别为非 EMS 使用组的 1.22（1.03-1.44）和 EMS 使用组的 1.23（1.04-1.46）。
由于 COVID-19 暴露的不可预测性而导致的 ED 临时关闭导致急诊患者的院内死亡率增加，无论他们是否使用 EMS。为应对新的疫情爆发而准备区域 EMS 系统对于保护所有公民的安全至关重要。
