Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Brussels, Belgium.
Emergency Department, GZA Hospitals Campus Sint-Vincentius, Antwerp, Belgium.
Prehosp Disaster Med. 2022 Feb;37(1):12-18. doi: 10.1017/S1049023X21001278. Epub 2021 Nov 22.
There is evidence to suggest that patients delayed seeking urgent medical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A delay in health-seeking behavior could increase the disease severity of patients in the prehospital setting. The combination of COVID-19-related missions and augmented disease severity in the prehospital environment could result in an increase in the number and severity of physician-staffed prehospital interventions, potentially putting a strain on this highly specialized service.
The aim was to investigate if the COVID-19 pandemic influences the frequency of physician-staffed prehospital interventions, prehospital mortality, illness severity during prehospital interventions, and the distribution in the prehospital diagnoses.
A retrospective, multicenter cohort study was conducted on prehospital charts from March 14, 2020 through April 30, 2020, compared to the same period in 2019, in an urban area. Recorded data included demographics, prehospital diagnosis, physiological parameters, mortality, and COVID-status. A modified National Health Service (NHS) National Early Warning Score (NEWS) was calculated for each intervention to assess for disease severity. Data were analyzed with univariate and descriptive statistics.
There was a 31% decrease in physician-staffed prehospital interventions during the period under investigation in 2020 as compared to 2019 (2019: 644 missions and 2020: 446 missions), with an increase in prehospital mortality (OR = 0.646; 95% CI, 0.435 - 0.959). During the study period, there was a marked decrease in the low and medium NEWS groups, respectively, with an OR of 1.366 (95% CI, 1.036 - 1.802) and 1.376 (0.987 - 1.920). A small increase was seen in the high NEWS group, with an OR of 0.804 (95% CI, 0.566 - 1.140); 2019: 80 (13.67%) and 2020: 69 (16.46%). With an overall decrease in cases in all diagnostic categories, a significant increase was observed for respiratory illness (31%; P = .004) and cardiac arrest (54%; P < .001), combined with a significant decrease for intoxications (-58%; P = .007). Due to the national test strategy at that time, a COVID-19 polymerase chain reaction (PCR) result was available in only 125 (30%) patients, of which 20 (16%) were positive.
The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality. Further investigation is needed to fully understand the reasons for these changes.
有证据表明，在 2019 年冠状病毒病（COVID-19）大流行的第一波期间，患者延迟寻求紧急医疗救助。健康寻求行为的延迟可能会增加院前环境中患者的疾病严重程度。与 COVID-19 相关任务以及院前环境中疾病严重程度的增加相结合，可能会导致需要进行医生配备的院前干预的数量和严重程度增加，从而可能对这项高度专业化的服务造成压力。
旨在调查 COVID-19 大流行是否会影响需要医生配备的院前干预的频率、院前死亡率、院前干预期间的疾病严重程度以及院前诊断的分布。
对 2020 年 3 月 14 日至 4 月 30 日期间的城市地区院前图表进行回顾性、多中心队列研究，并与 2019 年同期进行比较。记录的数据包括人口统计学资料、院前诊断、生理参数、死亡率和 COVID 状况。为每个干预措施计算了改良的英国国家卫生服务（NHS）早期预警评分（NEWS），以评估疾病严重程度。使用单变量和描述性统计数据进行数据分析。
与 2019 年相比（2019 年：644 次任务，2020 年：446 次任务），2020 年调查期间需要医生配备的院前干预减少了 31%，而院前死亡率增加（OR=0.646；95%CI，0.435-0.959）。在研究期间，低和中 NEWS 组分别显著减少，OR 值分别为 1.366（95%CI，1.036-1.802）和 1.376（0.987-1.920）。高 NEWS 组略有增加，OR 值为 0.804（95%CI，0.566-1.140）；2019 年：80（13.67%）和 2020 年：69（16.46%）。由于所有诊断类别的病例总体减少，呼吸道疾病（31%；P=0.004）和心搏骤停（54%；P<.001）显著增加，同时中毒（-58%；P=0.007）显著减少。由于当时的全国检测策略，仅在 125 名（30%）患者中获得了 COVID-19 聚合酶链反应（PCR）结果，其中 20 名（16%）为阳性。
需要医生配备的院前干预的频率显著下降。较低疾病严重程度的干预明显减少，而较高疾病严重程度和死亡率的干预增加。需要进一步调查以充分了解这些变化的原因。
