Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Accident and Emergency Department, Queen Mary Hospital, Hong Kong SAR, China.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Ann Emerg Med. 2022 Feb;79(2):148-157. doi: 10.1016/j.annemergmed.2021.09.424. Epub 2021 Sep 24.
We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong.
We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality.
ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality.
A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.
本研究旨在评估和描述与香港 COVID-19 大流行早期阶段相关的急诊科（ED）就诊次数和超额死亡率的规模和关系。
我们进行了一项全港范围的回顾性队列研究，比较了 COVID-19 大流行对 ED 就诊次数和死亡率的影响。将 2019 年 1 月 1 日至 8 月 31 日期间香港 18 家公立医院的所有 ED 就诊次数（2019 年为 1,426,259 例，2020 年为 1,035,562 例）纳入研究。主要结局是 ED 就诊后 28 天内的全因死亡率。次要结局是每周 ED 就诊次数和特定疾病的死亡率。
ED 就诊次数减少了 27.4%，从 2019 年的 1,426,259 次减少到 2020 年的 1,035,562 次。总死亡率从 2019 年的 28,686 例（2.0%）增加到 2020 年的 29,737 例（2.9%）。2020 年大流行期间 28 天全因死亡率的调整比值比（OR）为 1.26（95%置信区间 1.24 至 1.28）。男女、年龄大于 45 岁、所有分诊类别、所有社会阶层、所有 ED 就诊时段、癫痫（OR 1.58，95%置信区间 1.20 至 2.07）、下呼吸道感染和气道疾病的全因死亡率的调整 OR 更高。
COVID-19 大流行的前 8 个月，ED 就诊次数显著减少，与 ED 确诊死亡人数增加有关。政府必须提供相关措施，鼓励有报警症状、心理健康状况和合并症的患者及时寻求紧急护理，无论大流行与否。
