Gerçekten Acil Olan Olgular mı Acil Servise Başvuruyor: Bir Pandeminin Gösterdikleri

Year 2023, Volume: 6 Issue: 1, 25 - 31, 08.03.2023

Seyran Bozkurt Babuş , Çağrı Safa Buyurgan , Ataman Köse , Akif Yarkaç , Gülhan Temel , Hakan Aytan

https://doi.org/10.54996/anatolianjem.1177098

Abstract

Amaç: COVID-19 salgınının dünya çapında büyük sağlık ve toplumsal etkileri oldu. COVID-19 pandemisinin acil servis başvurularındaki göreceli değişikliği tanımlamak ve acil servise (AS) başvuran hastaların profilini ortaya çıkarmak amaçlandı.

Gereç ve Yöntemler: Pandeminin belirli bir dönemi olan 11.03.2020-23.04.2020 tarihleri arası ve ona denk düşen pandemik olmayan 11.03.2019-23.04.2019 tarihleri arasında AS’e başvuran 18 yaş ve üstü hastaların verileri retrospektif olarak inecelendi. İki dönemde AS’e başvuran hastaların sıklığı, sosyodemografik, klinik ve maliyet özellikleri karşılaştırıldı.

Bulgular: AS’e hasta başvuru oranı pandemi olmayan dönemde %69.6 iken, pandemi döneminde %30.4 olarak hesaplanmıştır (p<0.001). Pandemi olmayan dönemde 18-24 yaş (p<0.001), pandemi döneminde 45-64 ve ≥ 65 yaş gurubundaki hastaların başvuru oranlarının daha yüksek olduğu tespit edildi (p<0.001). Pandemi döneminde ambulansla transfer edilen hasta oranının (p<0.001), “çok acil” hasta başvuru oranının (p<0.001), konsültasyon (p<0.001) ve laboratuvar tetkik istenme oranlarının daha yüksek olduğu tespit edildi (p<0.001). Pandemi döneminde servis ve yoğun bakıma yatırılan hasta oranları daha fazlaydı (p<0.001). Pandemi olmayan dönemde ölüm oranı %0.7 iken, pandemi döneminde bu oran %1.6 tespit edildi (p<0.001). Pandemi olmayan dönemde başvuran hastalarda toplam fatura, pandemi döneminde başvuran hastalarda ise ortalama fatura tutarı daha yüksek tespit edildi (p<0.001). Pandemi döneminde başvuran hastaların ambulansla AS’e transfer edilme (OR 9.947, CI 8.65-11.44), çok acil triaj kategorisinde olma (OR 1.892, CI 1.712-2.09), hastanede ölüm (OR 2.263, CI 1.69-3.03) riskinin daha fazla olduğu ve toplam fatura tutarının her birimlik artış için 1.004 kat arttığı tespit edildi.

Sonuç: Pandemi dönemde AS’e genel hasta başvuru oranı ve acil olmayan başvuru oranları azalırken, “çok acil” olan hasta başvurusu, mortalite ve hasta başı maliyet artmıştır. Çalışmamızdan elde edilen bulgular acil servislerin yoğunluğunu azaltmak için gelecekteki müdahalelere rehberlik edebilir.

Keywords

Acil servis, COVID-19 pandemisi, hasta özellikleri, maliyet

Supporting Institution

yok

Project Number

yok

Do Really Urgent Cases Present to the Emergency Department: What a Pandemic Has Shown

Abstract

Aim: The COVID-19 pandemic has had significant health and social impacts globally. This study aimed to describe the variance in emergency department admissions during the COVID-19 pandemic and to reveal the profile of patients admitted to the emergency department (ED).

Material and Methods: Data from patients in the ED between 11.03.2020-23.04.2020, which is a period of the pandemic, and 11.03.2019-23.04.2019, which is the non-pandemic period, was retrospectively analyzed. The frequency, demographic and clinical characteristics, and financial costs of patients admitted to the ED in those two periods were compared.

Results: While the ratio of patients presenting to the emergency department was 69.6% in the non-pandemic period, it was calculated to be 30.4% in the pandemic period (p < 0.001). A higher admission rate was found in patients aged 18-24 years during the non-pandemic period and in patients aged 45-64 years and ≥ 65 years during the pandemic period (p<0.001). It was determined that the rate of patients transferred by ambulance (p<0.001), the rate of “very urgent” patient admission (p<0.001), and requirements for consultation (p<0.001) and laboratory tests were higher during the pandemic period (p<0.001). During the pandemic period, the rates of patients who needed hospitalization and admission to intensive care units (ICU) were higher (p<0.001). While the mortality rate was 0.7% in the non-pandemic period, this rate was 1.6% in the pandemic period (p<0.001). The total invoice amount was higher in patients who presented during the non-pandemic period, and the mean invoice amount was higher in patients who presented during the pandemic period (p < 0.001). Patients who presented during the pandemic period had a higher risk of being transferred to the emergency department by an ambulance (OR 9.947, CI 8.65–11.44), being in the very urgent triage category (OR 1.892, CI 1.712–2.09), in-hospital mortality (OR 2.263, CI 1.69–3.03), and the total invoice amount increased by 1.004 times for each unit increase.

Conclusion: Although overall and non-urgent patient visits to the ED during the pandemic period were found to be decreased, “very urgent” patient visits, mortality, and costs per patient were found to be increased.

Keywords

Emergency department, COVID-19 pandemic, cost, patient characteristics

Project Number

yok

References

• Durand AC, Gentile S, Gerbeaux P, Alazia M, Kiegel P, Luigi S, et al. Be careful with triage in emergency departments; interobserver agreement on 1,578 patients in France. BMC Emergency Medicine 2011;11:19. doi: 10.1186/1471-227X-11-19.
• Durand AC, Gentile S, Devictor B, Palazzolo S, Vignally P. Gerbeaux P, et al. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. The American Journal of Emergency Medicine 2011;29(3):333-45 doi: 10.1016/j.ajem.2010.01.003.
• Jones SS, Thomas A, Evans RS, Welch SJ, Haug PJ. Snow GL. Forecasting daily patient volumes in the emergency department. Academic Emergency Medicine 2008;15(2):159-70. doi: 10.1111/j.1553-2712.2007.00032.x
• Katayama Y, Kiyohara K, Kitamura T, Hayashida S, Shimazu T. Influence of the COVID-19 pandemic on an emergency medical service system: a population-based, descriptive study in Osaka, Japan. Acute Medicine and Surgery 2020;7(1):e534. doi: 10.1002/ams2.534
• Lange SJ, Ritchey MD, Goodman AB, Dias T, Twentyman E, Fuld J, et al. Potential ındirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions - United States, January-May 2020. Morbidity And Mortality Weekly Report 2020;69(25):795-800. doi: 10.15585/mmwr.mm6925e2.
• Hughes HE, Hughes TC, Morbey R, Challen K, Oliver I, Smith GE, et al. Emergency department use during COVID-19 as described by syndromic surveillance. Emergency Medicine Journal 2020;37(10):600-604. doi: 10.1136/emermed-2020-209980
• Nuñez JH, Sallent A, Lakhani K, Guerra-Farfan E, Vidal N, Ekhtiari S, et al. Impact of the COVID-19 pandemic on an emergency traumatology service: experience at a tertiary trauma centre in Spain. Injury. 2020;51(7):1414-1418.
• Lateef F. SARS changes the ED paradigm. American Journal of Emergency Medicine 2004;22(6):483-7. doi: 10.1016/j.ajem.2004.07.015.
• Paek SH, Kim DK, Lee JH, Kwak YH. The ımpact of middle east respiratory syndrome outbreak on trends in emergency department utilization patterns. Journal of Korean Medical Science 2017;32(10):1576-1580. doi: 10.3346/jkms.2017.32.10.1576.
• McDonnell WM, Nelson DS, Schunk JE: Should we fear “flu fear” itself? Effects of H1N1 influenza fear on ED use. American Journal of Emergency Medicine 2012, 30:275-82. doi: 10.1016/j.ajem.2010.11.027
• Nourazari S, Davis SR, Granovsky R, Austin R, Straff DJ, Joseph JW, et al. Decreased hospital admissions through the emergency department during the COVID-19 pandemic. American Journal of Emergency Medicine 2021; 42:203–210. doi: 10.1016/j.ajem.2020.11.029
• Hooker EA, Mallow PJ, Oglesby MM. Characterıstıcs and trends of emergency department vısıts ın the Unıted States (2010–2014). The Journal of Emergency Medicine 2019;56(3):344-351. doi: 10.1016/j.jemermed.2018.12.025.
• Scaramuzza A, Tagliaferri F, Bonetti L, Soliani M, Morotti F, Bellone S, et al. Changing admission patterns in paediatric emergency departments during the COVID-19 pandemic. Archives Of Disease İn Childhood 2020 Jul;105(7):704-706. doi: 10.1136/archdischild-2020-319397
• Leow SH, Dean W, MacDonald-Nethercott M, MacDonald-Nethercott E, Boyle AA. The attend study: a retrospective observational study of emergency department attendances during the early stages of the COVID-19 pandemic. Cureus 2020 Jul 21;12(7):e9328. doi: 10.7759/cureus.9328.
• NHS Digital: Hospital Episode Statistics (HES) . (2019). Accessed: May 20, 2020: https://digital.nhs.uk/data-and-information/data-tools-and-services/data- services/hospitalepisode-statistics
• Hartnett KP, Kite-Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, et al. National Syndromic Surveillance Program Community of Practice. Impact of the COVID-19 pandemic on emergency department visits - United States, January 1, 2019-May 30, 2020. Morbidity And Mortality Weekly Report 2020;69(23):699-704. doi: 10.15585/mmwr.mm6923e1
• Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Deciding to visit the emergency department for non-urgent conditions: a systematic review of the literature. The American Journal Of Managed Care 2013; 19(1): 47–59.
• Çevik C, Tekir O. Emergency service admission evaluation of diagnosis codes, triage and socio-demographic. Balıkesir Health Sciences Journal 2014;3(2):102-107 (in Turkish). doi:10.5505/bsbd.2014.26349
• LaCalle EJ, Rabin EJ, Genes NG. High-frequency users of emergency department care. The Journal of Emergency Medicine 2013;44(6):1167-1173. doi: 10.1016/j.jemermed.2012.11.042
• Şimşek DÖ. General overview of triage scales and determination of factors affecting emergency service applications in Turkey by logistic regression. Journal Of Social Insurance. 2018;13:84-115 (ın Turkish). doi: 10.21441/sguz.2018.66
• Aydın T, Aydın ŞA, Köksal Ö, Özdemir F, Kulaç S, Bulut M. Evaluation of features of patients attending the emergency department of Uludag University medicine faculty hospital and emergency department practices. The Journal of Academic Emergency Medicine 2010; 9(4):163-8
• Kılıçaslan I, Bozan H, Oktay C, Göksu E. Demographic properties of patients presenting to the emergency department in Turkey. Turkish Journal of Emergency Medicine 2005;5(1):5-13
• Miller JB, Brauer E, Rao H, Wickenheiser K, Dev S, Omino R, et al. The most frequent ED patients carry insurance and a significant burden of disease. American Journal of Emergency Medicine 2013;31:16-19
• Zeytin AT, Cevik AA, Acar N, Kaya S, Ozçelik H. Characteristics of patients presenting to the academic emergency department in central Anatolia. Turkish Journal of Emergency Medicine 2014;14(2):75-81. doi: 10.5505/1304.7361.2014.91489
• Jeffery MM, D'Onofrio G, Paek H, Platts-Mills TF, Soares WE 3rd, Hoppe JA, et al. Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US. Journal of the American Medical Association İnternal Medicine 2020;180(10):1328-1333. doi: 10.1001/jamainternmed.2020.3288.
• Westgard BC, Morgan MW, Vazquez-Benitez G, Erickson LO, Zwank MD. An analysis of changes in emergency department visits after a state declaration during the time of COVID-19. Annals of Emergency Medicine 2020;76(5):595-601. doi: 10.1016/j.annemergmed.2020.06.019
• Kim HS, Cruz DS, Conrardy MJ, Gandhi KR, Seltzer JA, et al. Emergency Department Visits for Serious Diagnoses During the COVID-19 Pandemic. Academic Emergency Medicine 2020;27(9):910-913. doi: 10.1111/acem.14099
• Oktay C, Cete Y, Eray O, Pekdemir M, Gunerli A. Appropriateness of emergency department visits in a Turkish university hospital. Croatian Medical Journal 2003;44(5):585-591
• McDonnell T, McAuliffe E, Barrett M, Conlon C, Cummins F, Deasy C, et al. CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol [version 2; peer review: 2 approved]. Health Research Board Open Research 2020; 3: 37. doi: 10.12688/hrbopenres.13066.2