National Emergency Medical Center, National Medical Center, Seoul, Korea.
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2021 Apr 26;36(16):e121. doi: 10.3346/jkms.2021.36.e121.
The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period.
This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak.
The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74-0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57-0.83) for the patients with acute myocardial infarction and 0.76 (0.67-0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: -5.3 [-6.5 to -4.2] minutes in phase 5 compared to phase 3).
Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing in-hospital mortality by preventing excessive deaths.
本研究旨在回顾韩国 2019 年冠状病毒病（COVID-19）大流行期间与急救相关的国家卫生政策，并分析这些政策对在此期间前往急诊部（ED）的患者安全的影响。
这是一项准实验研究。研究人群为使用国家急诊部信息系统（NEDIS）数据库于 2019 年 12 月 31 日至 2020 年 5 月 13 日期间访问韩国所有 402 个 ED 的患者。根据传染病国家危机预警级别和实施急救相关卫生政策，将研究期分为 5 个阶段，所有研究阶段均为 27 天。主要结局为住院死亡率，次要结局为 COVID-19 爆发期间 ED 的住院时间（LOS）。
研究期间 ED 就诊人数为 2636341 人，住院死亡率为 1.4%。在此期间，ED 就诊人数从第 1 阶段的 803160 人减少到第 5 阶段的 496619 人。就住院死亡率而言，与第 3 阶段相比，第 5 阶段调整后的优势比（OR）（95%置信区间）为 0.77（0.74-0.79）。此外，按亚组分析，与第 3 阶段相比，急性心肌梗死患者的 OR 为 0.69（0.57-0.83），严重创伤患者的 OR 为 0.76（0.67-0.87）。随着 COVID-19 大流行的发展，ED 就诊人数减少，而 ED LOS 增加，政策实施后 ED LOS 下降（第 5 阶段与第 3 阶段相比，β系数为-5.3[6.5 至-4.2]分钟）。
在 COVID-19 大流行期间实施适当的急救政策有助于通过预防过度死亡来提高所有急诊患者的安全性并降低住院死亡率。
