Anaphylaxis and digital medicine.

PURPOSE OF REVIEW: Digital medicine (mHealth) aims to help patients and healthcare providers (HCPs) improve and facilitate the provision of patient care. It encompasses equipment/connected medical devices, mHealth services and mHealth apps (apps). An updated review on digital health in anaphylaxis is proposed. RECENT FINDINGS: In anaphylaxis, mHealth is used in electronic health records and registries.It will greatly benefit from the new International Classification of Diseases-11 rules and artificial intelligence. Telehealth has been revolutionised by the coronavirus disease 2019 pandemic, and lessons learnt should be extended to shared decision making in anaphylaxis. Very few nonvalidated apps exist and there is an urgent need to develop and validate such tools. SUMMARY: Although digital health appears to be of great importance in anaphylaxis, it is still insufficiently used.

After Action Reviews of COVID-19 response: Case study of a large tertiary care hospital in Italy.

BACKGROUND: After-Action Reviews (AARs) are management tools used to evaluate the response to public health emergencies at the national and subnational level. Aim of this study is to apply available AAR models to assess and critically appraise COVID-19 response of San Raffaele Scientific Institute, a large university hospital in Milan, Italy. METHODS: We designed an AAR based on the key-informant interview format, following the methodology proposed by the 2019 World Health Organization Guidance for AAR. After systematic assessment of the hospital reorganization, we conducted 36 semi-structured interviews to professionals with executive, clinical, technical and administrative roles. We designed an ad-hoc questionnaire exploring four areas: (i) staff management; (ii) logistics and supplies; (iii) COVID-19 diagnosis and clinical management; (iv) communication. RESULTS: Overall, the hospital response was evaluated as effective and sufficiently prompt. Participants stressed the relevance of: (i) strong governance and coordination; (ii) readiness and availability of healthcare personnel; (iii) definition of a model of care based on a multidisciplinary approach. Challenges were reported for communication management and staff training. CONCLUSIONS: This study is one of the first applications of the AAR to the COVID-19 response in hospital settings, which can be successfully adapted or scaled up to other settings in order to implement preparedness strategies for future public health emergencies.

Automated tracking of emergency department abdominal CT findings during the COVID-19 pandemic using natural language processing.

PURPOSE: During the COVID-19 pandemic, emergency department (ED) volumes have fluctuated. We hypothesized that natural language processing (NLP) models could quantify changes in detection of acute abdominal pathology (acute appendicitis (AA), acute diverticulitis (AD), or bowel obstruction (BO)) on CT reports. METHODS: This retrospective study included 22,182 radiology reports from CT abdomen/pelvis studies performed at an urban ED between January 1, 2018 to August 14, 2020. Using a subset of 2448 manually annotated reports, we trained random forest NLP models to classify the presence of AA, AD, and BO in report impressions. Performance was assessed using 5-fold cross validation. The NLP classifiers were then applied to all reports. RESULTS: The NLP classifiers for AA, AD, and BO demonstrated cross-validation classification accuracies between 0.97 and 0.99 and F1-scores between 0.86 and 0.91. When applied to all CT reports, the estimated numbers of AA, AD, and BO cases decreased 43-57% in April 2020 (first regional peak of COVID-19 cases) compared to 2018-2019. However, the number of abdominal pathologies detected rebounded in May-July 2020, with increases above historical averages for AD. The proportions of CT studies with these pathologies did not significantly increase during the pandemic period. CONCLUSION: Dramatic decreases in numbers of acute abdominal pathologies detected by ED CT studies were observed early on during the COVID-19 pandemic, though these numbers rapidly rebounded. The proportions of CT cases with these pathologies did not increase, which suggests patients deferred care during the first pandemic peak. NLP can help automatically track findings in ED radiology reporting.

Effect of the COVID-19 pandemic on CT scans ordered from the emergency department for abdominal complaints.

PURPOSE: The COVID-19 pandemic has affected healthcare systems and patients alike across the USA. We seek to elucidate changes in abdominal imaging ordered from the emergency department (ED) in a healthcare system undergoing non-surge conditions in April 2020 compared to April 2019. METHODS: We performed a retrospective, observational study comparing patients undergoing CT scans of the abdomen and pelvis ordered from the ED in April 2020 vs. April 2019 at a single healthcare center. Via review of the radiology report and electronic medical record, we determined the positive or negative status of these scans. We evaluated percentages of positive CT scans and differences in outcomes, including admission rates, interventions, and mortality. RESULTS: Comparing 2020 to 2019, there was a 31.6% decrease in the number of CT scans performed from the ED. We found a higher percentage of positive CT findings, 58.2% vs. 50.8% (p = 0.025), and increased admission rates, 40.8% vs. 34.1% (p = 0.036). Differences were found in rates of appendicitis, colitis, and cholangitis. No difference was found in ICU admissions, interventions, or in-hospital mortality. CONCLUSION: During the COVID-19 pandemic in a region undergoing non-surge conditions, we found increased rates of positive CT scans performed from the ED for abdominal complaints with an increased percentage of hospital admissions compared to a control year. No differences in ICU admissions or rates of procedural intervention were found to suggest higher acuity of pathology on presentation. Our findings suggest appropriately decreased healthcare utilization in our study period, driven by pre-hospital patient self-selection.

Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data.

BACKGROUND: Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. AIM: To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals. METHOD: We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups. RESULTS: One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively). CONCLUSION: One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis.

PURPOSE: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute nontraumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic. METHODS: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute nontraumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently, and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control. RESULTS: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). CONCLUSIONS: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

Sauna bathing frequency in Finland and the impact of COVID-19.

OBJECTIVES: Recent research has revealed multiple potential health benefits of frequent sauna bathing. Finland is a country with extraordinary sauna culture and bathing opportunities. However, coronavirus disease 2019 (COVID-19) pandemic introduced regulations and unprecedented closures to shared sauna facilities. In this study we aimed to examine the previously unknown baseline bathing frequency and its possible change during the epidemic. DESIGN: We investigated several aspects of sauna bathing with self-reports: the frequency, its possible changes, reasons for change, and beliefs about its health effects among a representative sample of thousand Finns aged 18-75 years. This online survey was administered in May 2020. RESULTS: Before the pandemic, 59 % of our respondents had enjoyed sauna at least once a week. Since the pandemic began, up to 23 % had reduced or stopped their bathing. This was often due to restricted sauna access. However, 11 % of respondents bathed more frequently and attributed this change to seeking relaxation and passing time. These findings demonstrate a surprising flexibility in this health-promoting national pastime. Men were more active bathers than women overall and women under 35 enjoy sauna more seldom than older women. Only 7.9 % of all respondents bathed at least four times a week, exceeding a suggested threshold for maximum health benefits. CONCLUSIONS: Finnish people are active sauna bathers. The COVID-19 pandemic demonstrated that the frequency of bathing is dependent on good access to sauna facilities. This flexibility and wide access could be exploited to improve public health in the long term if more frequent bathing became a standard.

Impact of the COVID-19 pandemic on emergency CT head utilization in Ontario-an observational study of tertiary academic hospitals.

PURPOSE: To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the volume, indications, and results of CT heads performed in the emergency department (ED) at Canadian tertiary academic centers in Ontario. METHODS: A retrospective review of consecutive CT head examinations ordered through the ED during the early stages of the COVID-19 pandemic in Canada (March 12-April 8, 2020) was performed and compared with that during the pre-COVID-19 period (February 12-March 10, 2020). CT reports were reviewed for the exam indication and the presence of predefined acute findings. A two-sample t test was utilized to compare the cohorts. Daily averages were calculated for all measures to control for the sample size difference between each period. A p value < 0.05 was considered significant. RESULTS: Of the total 751 CT head reports, 290 (38.6%) were ordered during the pandemic and 461 (61.4%) were ordered pre-pandemic. The average daily volume of CT head orders decreased significantly during COVID-19 compared with that during pre-COVID-19 (10.4 scans/day vs 16.5 scans/day; p = 0.001). In terms of indications, the frequency of "non-traumatic ICH" was significantly lower during COVID-19 compared with that during pre-COVID-19 (p = 0.01). Also, there was a significant increase in acute findings on CT during COVID-19 compared with that during pre-COVID-19 (p = 0.001). CONCLUSION: The decreased volume of emergency CT heads performed during the COVID-19 pandemic was associated with a significant increase in the proportion of cases with acute findings. This could be a result of the pandemic's influence on the health-seeking behavior of patients as well as the decision-making process of ordering clinicians.

Effect of COVID-19 on computed tomography usage and critical test results in the emergency department: an observational study.

BACKGROUND: The effect of the coronavirus disease 2019 (COVID-19) pandemic on new or unexpected radiologic findings in the emergency department (ED) is unclear. The aim of this study was to determine the effect of the COVID-19 pandemic on the number of computed tomography (CT) critical test results in the ED. METHODS: We performed a retrospective observational study of ED CT usage at 4 Ontario hospitals (1 urban academic, 1 northern academic, 1 urban community and 1 rural community) over 1 month during the COVID-19 pandemic (April 2020) and over the same month 1 year earlier (April 2019; before the pandemic). The CT findings from 1 of the 4 hospitals, Hamilton Health Sciences, were reviewed to determine the number of critical test results by body region. Total CT numbers were compared using Poisson regression and CT yields were compared using the χ2 test. RESULTS: The median number of ED CT examinations per day was markedly lower during the COVID-19 pandemic than before the pandemic (82 v. 133, p < 0.01), with variation across hospitals (p = 0.001). On review of 1717 CT reports from Hamilton Health Sciences, fewer critical test results were demonstrated on CT pulmonary angiograms (43 v. 88, p < 0.001) and CT examinations of the head (82 v. 112, p < 0.03) during the pandemic than before the pandemic; however, the yield of these examinations did not change. Although the absolute number of all CT examinations with critical test results decreased, the number of CT examinations without critical results decreased more, resulting in a higher yield of CT for critical test results during the pandemic (46% [322/696] v. 37% [379/1021], p < 0.01). INTERPRETATION: Emergency department CT volumes markedly decreased during the COVID-19 pandemic, predominantly because there were fewer examinations with new or unexpected findings. This suggests that COVID-19 public information campaigns influenced the behaviours of patients presenting to the ED.

Quantifying the decrease in emergency department imaging utilization during the COVID-19 pandemic at a multicenter healthcare system in Ohio.

PURPOSE: To illustrate the change in emergency department (ED) imaging utilization at a multicenter health system in the state of Ohio during the COVID-19 pandemic. METHODS: A retrospective observational study was conducted assessing ED imaging volumes between March 1, 2020, and May 11, 2020, during the COVID-19 crisis. A rolling 7-day total value was used for volume tracking and comparison. Total imaging utilization in the ED was compared with new COVID-19 cases in our region. Utilization was first categorized by modality and then by plain films and computed tomography (CT) scans grouped by body part. CT imaging of the chest was specifically investigated by assessing both CT chest only exams and CT chest, abdomen, and pelvis (C/A/P) exams. Ultimately, matching pair-wise statistical analysis of exam volumes was performed to assess significance of volume change. RESULTS: Our multicenter health system experienced a 46% drop in imaging utilization (p < 0.0001) during the pandemic. Matching pair-wise analysis showed a statistically significant volume decrease by each modality and body part. The exceptions were non-contrast chest CT, which increased (p = 0.0053), and non-trauma C/A/P CT, which did not show a statistically significant volume change (p = 0.0633). CONCLUSION: ED imaging utilization trends revealed through actual health system data will help inform evidence-based decisions for more accurate volume predictions and therefore institutional preparedness for current and future pandemics.

Effect of shelter-in-place on emergency department radiology volumes during the COVID-19 pandemic.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has led to significant disruptions in the healthcare system including surges of infected patients exceeding local capacity, closures of primary care offices, and delays of non-emergent medical care. Government-initiated measures to decrease healthcare utilization (i.e., "flattening the curve") have included shelter-in-place mandates and social distancing, which have taken effect across most of the USA. We evaluate the immediate impact of the Public Health Messaging and shelter-in-place mandates on Emergency Department (ED) demand for radiology services. METHODS: We analyzed ED radiology volumes from the five University of California health systems during a 2-week time period following the shelter-in-place mandate and compared those volumes with March 2019 and early April 2019 volumes. RESULTS: ED radiology volumes declined from the 2019 baseline by 32 to 40% (p < 0.001) across the five health systems with a total decrease in volumes across all 5 systems by 35% (p < 0.001). Stratifying by subspecialty, the smallest declines were seen in non-trauma thoracic imaging, which decreased 18% (p value < 0.001), while all other non-trauma studies decreased by 48% (p < 0.001). CONCLUSION: Total ED radiology demand may be a marker for public adherence to shelter-in-place mandates, though ED chest radiology demand may increase with an increase in COVID-19 cases.