Faculty of Medicine, Memorial University, St. John's, Canada.
Emerg Radiol. 2023 Jun;30(3):297-306. doi: 10.1007/s10140-023-02125-w. Epub 2023 Mar 29.
Investigating the effect of the COVID-19 lockdown on adult patient visits, computed tomography (CT) abdominal scans, and presentations of appendicitis and diverticulitis, to emergency departments (ED) in St. John's NL.
A retrospective quantitative analysis was applied, using ED visits and Canadian Triage and Acuity Scale (CTAS) scores. mPower (Nuance Communications, UK) identified CT abdominal scan reports, which were categorized into (1) normal/other, (2) appendicitis, or (3) diverticulitis. Time intervals included pre-lockdown (January-February), lockdown (March-June), and post-lockdown (July-August). Data from 2018 to 2019 (January-August) were used to generate expected patient volumes for 2020, and pre- and post-lockdown were included to control for other variables outside the lockdown.
Chi-squared goodness of fit tested for deviations from predicted means for 2018-2019. Compared to expectations, daily ED visits from January to August 2020 showed a significant (p < 0.001) decrease in patient volumes independent of gender, age, and CTAS scores. During and post-lockdown, CT abdominal scans did not drop in proportion to patient volume. Appendicitis presentations remained indifferent to lockdown, while diverticulitis presentations appeared to wane, with no difference in combined complicated cases in comparison to what was expected.
During lockdown, significantly fewer patients presented to the ED. The proportion of ordered CT abdominal scans increased significantly per person seen, without change in CTAS scores. Considering combined pathology cases increased during the lockdown, ED physicians were warranted in increasing abdominal imaging as patients did not avoid the ED. This may have resulted from a change in clinical practice where the uncertainty of COVID-19 increased CT scan usage.
调查 COVID-19 封锁对新斯科舍省圣约翰市成人患者就诊、计算机断层扫描 (CT) 腹部扫描以及阑尾炎和憩室炎就诊的影响。
采用回顾性定量分析，使用急诊就诊和加拿大分诊和急症程度评分 (CTAS)。mPower（英国 Nuance Communications）识别 CT 腹部扫描报告，并将其分为 (1) 正常/其他，(2) 阑尾炎，或 (3) 憩室炎。时间间隔包括封锁前 (1 月至 2 月)、封锁期间 (3 月至 6 月) 和封锁后 (7 月至 8 月)。使用 2018 年至 2019 年 (1 月至 8 月) 的数据生成 2020 年的预期患者量，并包括封锁前后的数据，以控制封锁以外的其他变量。
2018-2019 年的卡方拟合优度检验显示与预测均值的偏差。与预期相比，2020 年 1 月至 8 月期间，每日急诊就诊量显著减少 (p<0.001)，与性别、年龄和 CTAS 评分无关。在封锁期间和封锁后，CT 腹部扫描的数量并没有按比例减少。阑尾炎就诊仍然与封锁无关，而憩室炎就诊似乎有所减少，但与预期相比，复杂病例总数没有差异。
在封锁期间，到急诊就诊的患者明显减少。每就诊一人，所进行的 CT 腹部扫描的比例显著增加，而 CTAS 评分没有变化。考虑到封锁期间合并病例增加，急诊医生有理由增加腹部影像学检查，因为患者并没有回避急诊。这可能是由于 COVID-19 不确定性增加了 CT 扫描使用率，从而改变了临床实践。
