The Impact of the COVID-19 Pandemic and Socioeconomic Deprivation on Admissions to the Emergency Department for Psychiatric Illness: An Observational Study in a Province of Southern Italy.

The restriction measures adopted to limit population movement in order to contain the COVID-19 pandemic contributed to a global public health system crisis. This retrospective study aimed at identifying changes in psychiatric admissions to Accident and Emergency Departments (A&Es) in a province in southern Italy during the first two years of the pandemic and was characterized by two different restriction levels (phases 2 and 3) compared to the pre-pandemic period (phase 1). We also investigated the role of socioeconomic deprivation (DI) on psychiatric admissions. The total number of patients admitted to the A&Es was 291,310. The incidence of admission for a psychiatric disorder (IPd) was 4.9 per 1000 admissions, with a significant younger median age of 42 [IQR 33-56] compared to non-psychiatric patients (54 [35-73]). The type of admission and type of discharge were factors related to the psychiatric admission to A&E, and their relationship was modified by the pandemic. In the first year of the pandemic, patients with psychomotor agitation increased compared to the pre-pandemic period (72.5% vs. 62.3%). In the period preceding the spread of SARS-CoV-2, the IPd was equal to 3.33 ± 0.19; after the pandemic started, there was an increase in the IPd: 4.74 ± 0.32 for phase 2 and 3.68 ± 0.25 for phase 3. The IPd was higher for psychiatric admissions from areas with a very low DI compared to areas with a low DI; however, during phase 2, this difference was reduced. In conclusion, an increase in admissions for psychiatric disease was observed during the initial spread of SARS-CoV-2. Patients who lived in the most deprived municipalities generally came to the A&Es less than others, probably because the patients and their families had less awareness of their mental health. Therefore, public health policies to address these issues are needed to reduce the pandemic's impact on these conditions.

What is the health impact of COVID-19 among Black communities in Canada? A systematic review.

OBJECTIVE: The objective of this systematic review was to identify the health impact of COVID-19 on mortality, morbidity, hospital admission, and hospital readmission rates in the Black population across Canada. METHODS: A comprehensive search strategy consisting of relevant subject headings and keywords was executed in five databases: OVID Medline, OVID Embase, EBSCO CINAHL Plus, Web of Science, and Scopus. Additional searches were conducted for gray literature in ProQuest Dissertations and Theses Global, Google Scholar, and an advanced customized Google search for Canadian government documents. All eligible studies included in this review underwent quality assessment. RESULTS: Clinical health outcomes identified included mortality, morbidity, and hospital admission rates; none of the studies reported hospital readmission rates. The search identified 616 citations, and following the removal of duplicates and screening according to our inclusion/exclusion criteria, four articles were eligible for inclusion in the review. All of these studies were conducted in Canada. Study dates ranged from 2020 to 2021. CONCLUSION: A systematic review of studies on the impact of COVID-19 on the Black population in Canada highlights two key points. First, the collection and availability of race-based data are necessary to clarify the impact of COVID-19 and other diseases on Black populations in Canada. Second, with the limited available data, studies suggest that COVID-19 disproportionately impacts Black populations in Canada, making up high shares of cases, deaths, and hospitalizations compared to most of the population.

RéSUMé: OBJECTIF: L'objectif de cette revue systématique était d'identifier l'impact de la COVID-19 sur les taux de mortalité, de morbidité, d'admission à l'hôpital et de réadmission à l'hôpital dans la population noire au Canada. MéTHODES: Une stratégie de recherche complète composée des vedettes-matières et des mots-clés pertinents a été exécutée dans cinq bases de données : OVID Medline, OVID Embase, EBSCO CINAHL Plus, Web of Science et Scopus. Des recherches supplémentaires ont été effectuées pour la littérature grise dans ProQuest Dissertations and Theses Global, Google Scholar et une recherche Google personnalisée pour les documents du gouvernement canadien. Toutes les études éligibles incluses dans cette revue ont fait l'objet d'une évaluation de la qualité. RéSULTATS: Les résultats de santé cliniques identifiés comprenaient les taux de mortalité, de morbidité et d'admission à l'hôpital; aucune des études n'a rapporté de taux de réadmission à l'hôpital. La recherche a identifié 616 citations et à la suite de la suppression des doublons et de la sélection selon nos critères d'inclusion/exclusion, quatre articles étaient éligibles pour l'inclusion dans la revue. Toutes ces études ont été menées au Canada. Les dates des études allaient de 2020 à 2021. CONCLUSION: Une revue systématique des études sur l'impact de la COVID-19 sur la population noire au Canada met en évidence deux points clés. Premièrement, la collection et la disponibilité de données fondées sur la race sont nécessaires pour mieux comprendre l'impact de la COVID-19 et d'autres maladies sur les populations noires au Canada. Deuxièmement, avec les données disponibles, les études suggèrent que la COVID-19 a un impact disproportionné sur les populations noires au Canada, représentant des proportions élevées de cas, de décès et d'hospitalisations par rapport à la plupart de la population.

Outcomes of the same-day discharge following mastectomy before, during and after COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: The majority of patients undergoing mastectomy before the COVID-19 pandemic were admitted for 23-h observation to the hospital. Indications for observation included drain care education, pain control and observation for possible early surgical complications. This study compared the rates of outpatient mastectomy before, during, and after the COVID-19 pandemic and indirectly evaluated the safety of same-day discharge. METHODS: We retrospectively analyzed patients undergoing mastectomy using Current Procedural Terminology code 19303. RESULTS: A total of 357 patients were included: 113 were treated pre-COVID-19, 82 patients during COVID-19 and 162 post-COVID-19. The rate of outpatient mastectomies tripled during the pandemic from 17% to 51% (p < 0.001); after the pandemic remain high at 48%. The rate of bilateral mastectomies decreased during the pandemic to 30% from 48% prepandemic (p = 0.015). Pectoralis muscle block utilization increased during the COVID-19 period from 36% to 59% (p = 0.002). No difference in complication rates, including surgical site infections, hematomas, and readmissions, pre and during COVID. CONCLUSIONS: The rate of outpatient mastectomy increased during the COVID-19 pandemic. During this timeframe, perioperative complications did not increase, suggesting the safety of this practice. After the pandemic, the rate of outpatient mastectomy continued to be significantly higher than pre-COVID.

Aneurysmal subarachnoid hemorrhage in the pandemic era

Aneurysmal subarachnoid hemorrhage (SAH) is a neurovascular emergency with an often-malignant clinical course, requiring highly specialized treatment to maximize favorable outcomes. Since the outbreak of the COVID-19 pandemic in early 2020, there have been numerous reports from various fields of clinical medicine noting variations in the incidence of several clinical entities during the pandemic period in comparison with the baseline figures. Acute coronary syndromes are reportedly on the decline, as well as neurological emergencies in the form of acute stroke. The situation when it comes to aneurysmal SAH is more obscure, as several studies have been published with often conflicting results. Early reports noted a decline in SAH incidence, while several others claimed no significant variation or even a significant increase. A review of the available literature is presented in an attempt to draw insights into the impact of the pandemic on aneurysmal SAH. Conclusions are bound to facilitate rational healthcare resource reallocation, to effectively deal with COVID-19 while not neglecting patients suffering from threatening classical diseases. © 2022 by Nova Science Publishers, Inc. All rights reserved.

Trends of ischemic stroke admission during two years of COVID-19 pandemic: A retrospective cross-sectional study at a tertiary hospital in Indonesia

Introduction: There is no much information on how admission rates of non-coronavirus disease 2019 (COVID-19) diseases altered after two years of COVID-19 pandemic. The aim of this study was to determine the pattern of ischemic stroke admission rates within the two years of the COVID-19 pandemic in Indonesia.Method: A cross-sectional retrospective study investigated the admissions data of ischemic stroke was conducted at a tertiary hospital in Indonesia between January 2019 and December 2021. Ischemic stroke patients aged over 18 years old were identified using the ICD-10 I63 code. The data was accumulated every month and analyzed descriptively. We also analyzed the admissions data of ischemic stroke patients with COVID-19 and in-hospital mortality was calculated.Results: There were 2,710 ischemic stroke patients treated between 2019 and 2021 of which the number decreased from 1535 patients in 2019 to 730 in 2020 and only 445 cases in 2021. During 2019-2021, a total of 777 patients (28.67%) died during hospitalization;the most was in 2021 (33.3%). There is a consistent downward trend in ischemic stroke admissions during the COVID-19 pandemic with the monthly average admissions decreased 52.4% in 2020 compared to 2019 and 38.9% in 2021. Despite that, the mortality rate of ischemic stroke patients in the hospital increased from 26.5% in 2019 to 30.4% in 2020, and 33.3% in 2021. The number of ischemic stroke patients coinfected with COVID-19 was 3.5% (26/730) in 2020 and 8.1% (36/445) in 2021. Of all 62 ischemic stroke cases with COVID-19 in 2020-2021, 36 died yielded 58.1% in-hospital mortality rate. Conclusion: The decreased admissions and the increased mortality rate of ischemic stroke patients in particular those coinfected with COVID-19 during the first two years of pandemic should draw government attention to the necessity of improving stroke managements in Indonesia.

Stroke admissions during the COVID-19 pandemic: a single-center retrospective analysis.

BACKGROUND AND AIMS: The SARS-CoV-2 pandemic affected the organization of the healthcare system, and several studies analyzed the impact on hospitalization for non-COVID diseases, in particular during the first wave period. We sought to analyze the impact of the pandemic on stroke care in the province of Ferrara during a longer pandemic period and its different phases. METHODS: We retrospectively analyzed data of all patients with acute ischemic stroke admitted to the University Hospital of Ferrara from March 2020 to April 2021. Data were compared with nonpandemic reference periods (RP, March-April 2018 and 2019). RESULTS: We observed a 31% reduction in monthly admission rate for ischemic stroke (IRR 0.69; 95% CI 0.51-0.94) and monthly thrombolysis rate (IRR 0.3; 95% CI 0.15-0.66) during the first-COVID-wave (March-April 2020), as compared to RP. A nonsignificant difference was recorded for admission rate when comparing RP with subsequent pandemic phases, but the thrombolysis rate was confirmed reduced. A significant increase in onset to door time (OTD) was observed in the CP-I period (median 230 vs 120 in the RP; p < 0.05) with improvement in the subsequent phases but without returning to baseline. Nonsignificant differences in the thrombectomy rates were found over the study period. CONCLUSION: These findings reflect changing patient attitudes during the COVID-19 pandemic or the success of health system and public health campaigns to reassure patients about the safety of seeking emergency care when needed, not only for more severe stroke symptoms.

IMPACT OF COVID-19 PANDEMIC ON ST-SEGMENT-ELEVATION MYOCARDIAL INFARCTION ADMISSIONS AND OUTCOME IN THE NORTH OF IRAN

Objectives: To determine the incidence of ST-Elevation myocardial infarction (STEMI), patterns of care, and outcomes during the COVID-19 era in a hot-spot region. Methodology: From February to April 2020, all the STEMI patients were recruited and compared with the STEMI patients in the equivalent period of the previous year. Demographic and clinical information, coronary angiography data, and in-hospital mortality were collected and compared with the non-COVID-19 group. All data analysis was done using IBM SPSS version 20. Results: There was found a 40% reduction in STEMI admissions during the COVID-19 era compared to the equivalent period in 2019 (55 vs. 92, Rate Ratio (RR):0.60, 95% CI, 0.49-0.70, p<0.001). Compared with the pre-COVID-19 study group, STEMI patients hospitalized during the pandemic were significantly younger (mean age: 56.10 in 2020 vs. 60.83 in 2019 p=0.012). The percentage of primary percutaneous coronary intervention referral was significantly higher than the previous year (47.8% vs. 75.9% p=0.001). In-hospital death occurred in 4 (4.4%) of STEMI patients admitted before the COVID-19 time, while none of the COVID-19 period studied cases died in hospital (p=0.298). Conclusion: Admissions for STEMI were substantially reduced during the COVID-19 pandemic. No changes in overall in-hospital mortality or quality indicators were detected.

Admission Rate and Factors Associated with COVID-19 Disease in Children Attending the Emergency Department in Hospitals Affiliated to Mazandaran University of Medical Sciences, 2019-2020

Background and purpose: Coronavirus (COVID-19) in children includes 1 to 5% of all cases but child mortality due to the disease is rare. The aim of this study was to determine the admission rate and factors associated with Covid-19 disease in children to better understand and control the disease. Materials and methods: In a descriptive-analytical and cross-sectional study 594 samples were selected by systematic random sampling from 1847 children under 18 years of age attending the emergency departments affiliated with Mazandaran University of Medical Sciences. Information was collected from medical records and telephone interviews with parents using a researcher-made questionnaire. Data were analyzed in SPSS V21 applying descriptive statistics, Fisher Exact test, Spearman, Kruskal–Wallis test, and Mann Whitney U test. Results: The mean age of patients was 69.4±71.7 months and 53% were boys. Common symptoms included fever (67%) and cough (29%) and mortality rate was 0.3%. Underlying diseases were seen in 9.3% and seizure was more prevalent (27.3%). Contact with COVID-19 patients was reported by 18.69%. The most common diagnostic method was based on clinical symptoms (80%). Among the children studied, 92.6% were admitted to hospital, of whom 13.5% were admitted to ICU. The mean SpO2 was 96.6% and 13.1% of the patients required respiratory support. The average fear of parents about their child getting Covid-19 was reported to be 5.1. Conclusion: The disease is observed to be mild and moderate in children. Also, severity of the disease and the resulting mortality rate are higher in children with underlying diseases. The most important reason for the delay in referring to medical centers was fear of parents about their child developing COVID-19. © 2022, Mazandaran University of Medical Sciences. All rights reserved.

Comparison of Dementia Patients Admission Rates and Dementia Characteristics Before and During the COVID-19 Pandemic.

Background The coronavirus disease 2019 (COVID-19) epidemic was recognized as a pandemic by the World Health Organization on March 2020. There have been significant changes in our lives due to the measures used to prevent the spread of the COVID-19 pandemic. Dementia patients are one of the most vulnerable groups who have difficulties in adapting to this situation. Our study aimed to compare the admission rate to the hospital and dementia characteristics of dementia patients in the COVID-19 pandemic and pre-pandemic periods. Methods Dementia patients admitted to the neurology outpatient clinic during the pandemic and pre-pandemic periods were included in the study. In these two periods, age, gender, dementia type, stage, age of onset, mini-mental state examination, reason for admission, vitamin B12, vitamin D, folic acid levels, brain imaging, electroencephalogram results were analysed retrospectively. Dementia characteristics and vitamin levels were compared. Results Two hundred and two dementia patients were included in the study. When the reasons for admission to the hospital were examined, the number of applications with the complaint of forgetfulness was highest in the pre-COVID period (53.1%); this rate was 37.8% in the COVID period. Also, 9.5% of patients were admitted for a drug prescription or medication report during the COVID period, while this rate was 1.6% in the pre-COVID period. Brain imaging was performed on 91 patients in the pre-COVID period, while 42 patients underwent imaging in the COVID period. Conclusions Although this study was performed with a limited population, it indicates that the COVID-19 pandemic indirectly affects the clinical conditions of people living with dementia.

The effect of COVID-19 on the characteristics of adult emergency department visits: A retrospective cohort tertiary hospital experience in Riyadh.

BACKGROUND: On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients' demographic information, acuity level, length of stay, and admission rate. METHODS: Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19. RESULTS: The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime. CONCLUSION: We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.

Differential trends of admissions in accident and emergency departments during the COVID-19 pandemic in Germany.

BACKGROUND: Recent studies have shown a decrease of admissions to accident and emergency (A&E) departments after the local outbreaks of COVID-19. However, differential trends of admission counts, for example according to diagnosis, are less well understood. This information is crucial to inform targeted intervention. Therefore, we aimed to compare admission counts in German A&E departments before and after 12th march in 2020 with 2019 according to demographic factors and diagnosis groups. METHODS: Routine data of all admissions between 02.12.2019-30.06.2020 and 01.12.2018-30.06.2019 was available from six hospitals in five cities from north-western, eastern, south-eastern, and south-western Germany. We defined 10 diagnosis groups using ICD-10 codes: mental disorders due to use of alcohol (MDA), acute myocardial infarction (AMI), stroke or transient ischemic attack (TIA), heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), cholelithiasis or cholecystitis, back pain, fractures of the forearm, and fractures of the femur. We calculated rate ratios comparing different periods in 12.03.2020-30.06.2020 with 12.03.2019-30.06.2019. RESULTS: Forty-one thousand three hundred fifty-three cases were admitted between 12.03.2020-30.06.2020 and 51,030 cases between 12.03.2019-30.06.2019. Admission counts prior to 12.03. were equal in 2020 and 2019. In the period after 12.03., the decrease of admissions in 2020 compared to 2019 was largest between 26.03. and 08.04. (- 30%, 95% CI - 33% to - 27%). When analysing the entire period 12.03.-30.06., the decrease of admissions was heterogeneous among hospitals, and larger among people aged 0-17 years compared to older age groups. In the first 8 weeks after 12.03., admission counts of all diagnoses except femur fractures and pneumonia declined. Admissions with pneumonia increased in this early period. Between 07.05. and 30.6.2020, we noted that admissions with AMI (+ 13%, 95% CI - 3% to + 32%) and cholelithiasis or cholecystitis (+ 20%, 95% CI + 1% to + 44%) were higher than in 2019. CONCLUSIONS: Our results suggest differential trends of admission counts according to age, location, and diagnosis. An initial decrease of admissions with MDA, AMI, stroke or TIA, heart failure, COPD, cholelithiasis or cholecystitis, and back pain imply delays of emergency care in Germany. Finally, our study suggests a delayed increase of admissions with AMI and cholelithiasis or cholecystitis.

Effects of COVID-19 on the admissions of aneurysmal subarachnoid hemorrhage: the West Greece experience.

BACKGROUND: Acute subarachnoid hemorrhage (SAH) due to aneurysmal rupture is a devastating vascular disease accounting for 5% of strokes. COVID-19 pandemic resulted in a decrease in elective and emergency admissions in the majority of neurosurgical centers. The main hypothesis was that fear of COVID-19 may have prevented patients with critical medical or surgical emergencies from actively presenting in emergency departments and outpatient clinics. METHODS: We conducted a single-center, retrospective, observational study searching our institutional data regarding the incidence of spontaneous subarachnoid hemorrhage (SAH) and compare the admissions in two different periods: the pre COVID-19 with the COVID-19 period. RESULTS: The study cohort was comprised of a total of 99 patients. The mean (SD) weekly case rate of patients with SAH was 1.1 (1.1) during the pre-COVID-19 period, compared to 1.7 (1.4) during the COVID-19 period. Analysis revealed that the volume of admitted patients with SAH was 1.5-fold higher during the COVID period compared to the pre-COVID period and this was statistically significant (ExpB = 1.5, CI 95% 1-2.3, p = 0.044). Difference in mortality did not reach any statistical significance between the two periods (p = 0.097), as well as patients' length of stay (p = 0.193). CONCLUSIONS: The presented data cover a more extended time period than so far published reports; it is reasonable that our recent experience may well be demonstrating a general realistic trend of overall increase in aneurysmal rupture rates during lockdown. Hospitalization of patients with SAH cannot afford any reductions in facilities, equipment, or personnel if optimum outcomes are desirable.

Impact of national lockdown towards emergency department visits and admission rates during the COVID-19 pandemic in Thailand: A hospital-based study.

OBJECTIVE: To evaluate the impact of the national lockdown because of the 2019 coronavirus (COVID-19) pandemic towards the ED visits and admission rates in Thailand. METHODS: We retrospectively reviewed the electronic medical database of patients presenting to the ED during the national lockdown period (from 26 March to 30 June 2020). We used the same time interval in the year 2019 as the control period in our analysis. We collected baseline characteristics and outcomes of each patient in the ED. The primary outcome was the incidence rate ratio (IRR) with a 95% confidence interval (CI) of the average daily ED visits. Secondary outcomes included the IRR with 95% CI of total admissions and intensive care unit (ICU) admissions. RESULTS: The average number of daily ED visits decreased significantly from 89.1 to 57.0 (-36.0%, IRR 0.69, 95% CI 0.67-0.70). However, the proportions of 'Resuscitation' and 'Emergency' triage level were increased (29.1% vs 19.2%, P < 0.001). Total ED admission rate and ICU admission rate were also increased (33.5% vs 28.3%, P < 0.001 and 10.2% vs 7.5%, P < 0.001, respectively). The IRR for the admission rate was 1.18 (95% CI 1.11-1.26), and the IRR for the ICU admission rate was 1.35 (95% CI 1.21-1.52). CONCLUSION: The national lockdown in Thailand was associated with a significant reduction in average daily ED visits across traumatic and non-traumatic patients. Communication from healthcare professionals and public health officers is necessary to reinforce the importance of timely ED visits for acute health conditions.