Abstract
Objective: The coronavirus disease (COVID-19) pandemic has disrupted healthcare systems worldwide, resulting in decreased and delayed hospital visits of patients with non-COVID-19-related acute emergencies. We evaluated the impact of the COVID-19 pandemic on the presentation and outcomes of patients with non-COVID-19-related medical and surgical emergencies.
Method: All non-COVID-19-related patients hospitalized through emergency departments in three tertiary care hospitals in Saudi Arabia and Bahrain in June and July 2020 were enrolled and categorized into delayed and non-delayed groups (presentation ≥/=24 or <24 h after onset of symptom). Primary outcome was the prevalence and cause of delayed presentation; secondary outcomes included comparative 28-day clinical outcomes (i.e., 28-day mortality, intensive care unit (ICU) admission, invasive mechanical ventilation, and acute surgical interventions). Mean, median, and IQR were used to calculate the primary outcomes and inferential statistics including chi-square/Fisher exact test, t-test where appropriate were used for comparisons. Stepwise multivariate regression analysis was performed to identify the factors associated with delay in seeking medical attention.
Results: In total, 24,129 patients visited emergency departments during the study period, compared to 48,734 patients in the year 2019. Of the 256 hospitalized patients with non-COVID-19-related diagnoses, 134 (52%) had delayed presentation. Fear of COVID-19 and curfew-related restrictions represented 46 (34%) and 25 (19%) of the reasons for delay. The 28-day mortality rates were significantly higher among delayed patients vs. non-delayed patients ( n = 14, 10.4% vs. n = 3, 2.5%, OR: 4.628 (CI: 1.296-16.520), p = 0.038).
Conclusion: More than half of hospitalized patients with non-COVID-19-related diagnoses had delayed presentation to the ED where mortality was found to be significantly higher in this group. Fear of COVID-19 and curfew restrictions were the main reasons for delaying hospital visit.
Keywords: delayed presentation; emergency department; non-COVID-19 emergencies.
【저자키워드】 emergency department, delayed presentation, non-COVID-19 emergencies., 【초록키워드】 COVID-19, coronavirus disease, pandemic, Mortality, intensive care, COVID-19 pandemic, hospital, 28-day mortality, surgical, outcome, Saudi Arabia, ICU, Clinical outcome, Prevalence, Patient, group, fear, Admission, diagnose, Invasive mechanical ventilation, Healthcare system, regression analysis, Bahrain, Non-COVID-19, Factor, Primary outcome, diagnoses, study period, t-test, Comparisons, secondary outcome, tertiary care hospital, enrolled, resulting, identify, evaluated, was performed, median, onset of symptom, were used, hospitalized patient, significantly higher, calculate, IQR, patients hospitalized, seeking, 【제목키워드】 COVID-19, clinical, Impact, Emergency, Adverse, finding, Delayed, presentation,