Evaluating the effect of COVID-19 incidence on Emergency Departments admissions. Results from a retrospective study in Central Italy during the first year of pandemic.

Introduction: The COVID-19 pandemic has had a major impact on the Healthcare System, changing the patterns of Emergency Department access. In fact, accesses for trauma and less severe cases decreased significantly. This decline has generally been attributed to both the effects of the lockdown, imposed by the government, and the fear of being infected by SARS-CoV-2 in the hospital. However, the correlation between these elements is not yet clear, since the accesses to the Emergency Department did not increase either at the end of the lockdown or in the summer when the epidemiological situation was more favorable. Aim: To evaluate the association between trends of Emergency Department accesses and COVID-19 incidence in 2020. Methods: Data on Emergency Department accesses, by month and severity triage code, from 14 hospitals in southeastern Tuscany (Italy) were obtained from hospitals' data warehouse. Official data on new cases of COVID-19 infection were used to calculate incidence. Hospitals were classified into 4 categories. Differences in Emergency Department access by month, triage code, and hospital type were investigated using Kruskal-Wallis analysis. Association between Emergency Department accesses and COVID-19 incidence was evaluated using a random-effect panel data analysis, adjusting for hospital type and triage code. Results: The trend of 268,072 Emergency Department accesses decreases substantially at the first pandemic peak; thereafter, it increased and decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to be overlapping with an inverse direction. Monthly differences were significant (p<0.01) except for most severe codes. There was a significant inverse association between Emergency Department accesses and COVID-19 incidence (Coef. =-0.074, p<0.001) except for most severe cases (triage code 1: Coef. =-0.028, p=0.154). Conclusion: Emergency Department admissions trend followed the COVID-19 incidence, except for the most severe cases. Fear of infection seems to discourage patients from accessing Emergency Department for illnesses perceived as not serious.

COVID-19 incidence on Emergency Departments accesses. Health need and fear of infection, what wins? : Roberta Bosco

Introduction The COVID-19 pandemic has changed the patterns of access to the Emergency Department (ED), but it is unclear whether this change was due to COVID-19 incidence or the lockdown imposed by law. Aim To evaluate the association between trends of ED accesses and COVID-19 incidence in the period 1 January - 31 December 2020. Material and methods The data of accesses to the ED per month and severity triage code of 14 hospitals in the Southeast Tuscany (Italy, Provinces of Siena, Arezzo, Grosseto) were obtained from hospitals data warehouses. Data on new cases of COVID-19 infection (obtained by the Ministry of Health) for the 3 provinces were used to calculate the incidence of infection. Hospitals were classified in 4 categories based on beds number, medical specialties offered, services provided. Differences in ED accesses by month, triage code and hospital type were investigated by a Kruskal-Wallis analysis of variance. Association between ED accesses and COVID-19 incidence was evaluated using a random effect panel data analysis adjusting for hospital type and triage code. Results A total of 268,072 ED accesses have been studied. Their trends saw a strong decrease in correspondence of the first pandemic peak, subsequently they are increased and then decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to overlap, but in the reverse direction, with ED admissions trends. Monthly differences of the ED accesses were significant (p < 0.01) except for most severity code. There is a statistically significant inverse association between ED accesses and COVID-19 incidence (Coef. = -0.074, p < 0.001) except for most severe cases (triage code 1: Coef. = -0.028, p = 0.154). Conclusions ED admissions trends followed the COVID-19 incidence independently from the period of lockdown except for the most severe cases. The fear to contract the infection seemed to discourage patients to access ED for diseases that were perceived as not serious. Key messages • The pandemic has changed the lifestyle of people worldwide, modifying even the perception that the patient has of own state of health and their access to Emergency Department. • The decrease in accesses involved less severe cases. Reflect on both the adequacy of accesses in the pre-pandemic period and on what is the best setting to manage these cases in the pandemic period.

The prevalent clinical characteristics of hospitalized Covid-19 patients

The prevalent clinical characteristics of hospitalized Covid-19 patients Background. Data from hospitalized patients diagnosed with Covid-19 were analyzed to assess the prevalence of clinical and demographic characteristics. Methods. Data from all hospitalized patients diagnosed with Covid-19 in the 1 March 2020 – 5 May 2021 period were extracted from company databases. The demographic, clinical, and comorbidity data of hospitalised patients were compared with the PASSI study. Results. The sample consisted of 837 patients, 361 females (43%) and 476 males (57%), of whom 84% were discharged and 16% died. 1190 comorbidities were recorded: hypertension in 364 (43%) patients, diabetes in 154 (18%), obesity in 51 (6%), dyslipidemia in 94 (11%), COPD in 64 (8.0%), and asthma in 29 (3.0%). The 18-64 year age group of hospitalized patients shows a higher prevalence of comorbidity than the population for hypertension (24 vs 14%), diabetes (9 vs 3%), chronic respiratory diseases (9 vs 6%), heart disease (5 vs 3%), and renal insufficiency (2 vs 1%), and a lower prevalence for tumors (3 vs 4%). Patients in the over 65 age group had an inpatient disease lower than the population for hypertension (53 vs 61%), diagnosed disease (17 vs 40%), chronic renal failure (10 vs 11%), tumors (6 vs 13%), and a higher one for diabetes (23 vs 15%). Conclusions. Our analysis shows that, in young patients, comorbidities are a negative prognostic factor, while, in elderly patients, they are advanced age and comorbidities.

Pazienti ricoverati Covid-19: caratteristiche cliniche prevalenti

The prevalent clinical characteristics of hospitalized Covid-19 patients ►Background. Data from hospitalized patients diagnosed with Covid-19 were analyzed to assess the prevalence of clinical and demographic characteristics. ►Methods. Data from all hospitalized patients diagnosed with Covid-19 in the 1 March 2020 – 5 May 2021 period were extracted from company databases. The demographic, clinical, and comorbidity data of hospitalised patients were compared with the PASSI study. ►Results. The sample consisted of 837 patients, 361 females (43%) and 476 males (57%), of whom 84% were discharged and 16% died. 1190 comorbidities were recorded: hypertension in 364 (43%) patients, diabetes in 154 (18%), obesity in 51 (6%), dyslipidemia in 94 (11%), COPD in 64 (8.0%), and asthma in 29 (3.0%). The 18-64 year age group of hospitalized patients shows a higher prevalence of comorbidity than the population for hypertension (24 vs 14%), diabetes (9 vs 3%), chronic respiratory diseases (9 vs 6%), heart disease (5 vs 3%), and renal insufficiency (2 vs 1%), and a lower prevalence for tumors (3 vs 4%). Patients in the over 65 age group had an inpatient disease lower than the population for hypertension (53 vs 61%), diagnosed disease (17 vs 40%), chronic renal failure (10 vs 11%), tumors (6 vs 13%), and a higher one for diabetes (23 vs 15%). ►Conclusions. Our analysis shows that, in young patients, comorbidities are a negative prognostic factor, while, in elderly patients, they are advanced age and comorbidities. © 2021 Il Pensiero Scientifico Editore s.r.l.. All rights reserved.