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The early COVID-19 pandemic was associated with an average drop in emergency department (ED) volumes of 42% across the U.S. (MMWR 2020; 69:699). This has created concern that patients with life threatening conditions delayed seeking treatment.
Researchers analyzed trends in diagnoses of acute myocardial infarction (AMI), ischemic stroke, nontraumatic subarachnoid hemorrhage, ectopic pregnancy, and appendicitis at two health systems (Stanford University and New York-Presbyterian/Weill Cornell [NYP]) from March 1, 2018, to May 22, 2020. After March 1, 2020, there was a drop in the average daily number of all diagnoses except ectopic pregnancy at both centers. The drop in appendicitis diagnoses was statistically significant only at NYP. Reductions were greater at NYP than Stanford, ranging from 33% (nontraumatic subarachnoid hemorrhage) to 49% (ischemic stroke) at NYP and from 16% (ischemic stroke) to 33% (nontraumatic subarachnoid hemorrhage) at Stanford.
Bhambhvani HP et al. Hospital volumes of 5 medical emergencies in the COVID-19 pandemic in 2 US medical centers. JAMA Intern Med 2020 Oct 26; [e-pub]. (https://doi.org/10.1001/jamainternmed.2020.3982)
Comment
It is unlikely that the incidence of medical emergencies such as AMI or appendicitis changed during the COVID-19 pandemic; instead, these findings support the claim that patients have delayed seeking treatment. However, the data in this study are from the most severe, initial peak of COVID-19 in the U.S. It's unclear whether these findings will persist as ED visits return to near prepandemic volumes. Health systems and clinicians should continue to reassure patients to seek medical care if they feel unwell.