Liu Qi, Lin Bingcao, Zhu Changju, Hu Jianping
Department of Emergency Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Translational Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Med (Lausanne). 2022 Aug 4;9:929353. doi: 10.3389/fmed.2022.929353. eCollection 2022.
The coronavirus disease 2019 (COVID-19) pandemic as well as the subsequent prevention and control measures is like a quasi-experiment intervention that might have changed the features of emergency hospitalizations. Mortality is high in patient hospitalization due to emergency respiratory diseases (ERD). Therefore, we compared the characteristics of these patients before and during the pandemic. Exploring this issue might contribute to decision-making of emergency management when most of the resources and attention has been devoted to combat COVID-19.
This study was a retrospective observational cohort study. All emergency hospitalizations due to ERD from January 1, 2019 to December 31, 2020 in a tertiary hospital in China were included. Data including patients' age, sex, and clinical outcomes were extracted. Air quality was collected from the official online platform. Clinical characteristics were compared and odds ratios were calculated.
The ERD hospitalization rate was lower in 2020 than in 2019 (6.4 vs. 4.3%, = 55.449, = 0.000) with a 50.65% reduction; however, the patients were older in 2020 than in 2019 ( = 0.000) with a higher proportion of admission to the intensive care unit (ICU) (46 vs. 33.5%, = 20.423, = 0.000) and a longer ICU stay ( = 0.000). The overall intubation rate, hospital mortality, and rate of discharge due to ineffective treatment in 2020 were higher than those in 2019 (15.6 vs. 8%, = 18.578, = 0.000; 4.2 vs. 1.1%, = 4.122, = 0.000; 5.5 vs. 2.4%, = 8.93, = 0.000, respectively). The logistic regression analysis indicated hospitalizations due to ERD were mainly associated with PM2.5 and sulfur dioxide on the day, and on the 4th and 5th days before admission ( = 0.034 and 0.020, 0.021 and 0.000, 0.028, and 0.027, respectively) in 2019. However, in 2020, the relationship between parameters of air quality and hospitalization changed.
The COVID-19 pandemic has changed the characteristics of emergency hospitalization due to ERD with a larger proportion of severe patients and poorer prognosis. The effect of air quality on emergencies were weakened. During the COVID-19 pandemic, it is necessary to pay more attention to the non-COVID-19 emergency patients.
2019年冠状病毒病（COVID-19）大流行以及随后的防控措施就像是一种准实验性干预，可能改变了急诊住院的特征。因紧急呼吸道疾病（ERD）住院的患者死亡率很高。因此，我们比较了大流行之前和期间这些患者的特征。在大部分资源和注意力都投入到抗击COVID-19之时，探索这个问题可能有助于应急管理决策。
本研究为回顾性观察队列研究。纳入了2019年1月1日至2020年12月31日期间在中国一家三级医院因ERD而进行的所有急诊住院病例。提取了包括患者年龄、性别和临床结局的数据。从官方在线平台收集空气质量数据。比较临床特征并计算比值比。
2020年ERD住院率低于2019年（6.4%对4.3%，Z = 55.449，P = 0.000），降低了50.65%；然而，2020年患者年龄比2019年更大（P = 0.000），入住重症监护病房（ICU）的比例更高（46%对33.5%，Z = 20.423，P = 0.000），且在ICU停留时间更长（P = 0.000）。2020年总体插管率、医院死亡率和因治疗无效出院率均高于2019年（15.6%对8%，Z = 18.578，P = 0.000；4.2%对1.1%，Z = 4.122，P = 0.000；5.5%对2.4%，Z = 8.93，P = 0.000）。逻辑回归分析表明，2019年因ERD住院主要与当日以及入院前第4天和第5天的细颗粒物（PM2.5）和二氧化硫有关（P值分别为0.034和0.020、0.021和0.000、0.028和0.027）。然而，2020年空气质量参数与住院之间的关系发生了变化。
COVID-19大流行改变了因ERD急诊住院的特征，重症患者比例更高，预后更差。空气质量对急诊的影响减弱。在COVID-19大流行期间，有必要更加关注非COVID-19急诊患者。
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