在安大略省COVID-19大流行的第一年,因选定的紧急诊断而从急诊科住院:一项基于人群的回顾性研究

CMAJ open Pub Date : 2023-10-24 Print Date: 2023-09-01 DOI:10.9778/cmajo.20230017
Keerat Grewal, Clare L Atzema, Rinku Sutradhar, Winnie Yu, Lucas B Chartier, Steven M Friedman, Megan Landes, Bjug Borgundvaag, Shelley L McLeod
{"title":"在安大略省COVID-19大流行的第一年,因选定的紧急诊断而从急诊科住院:一项基于人群的回顾性研究","authors":"Keerat Grewal,&nbsp;Clare L Atzema,&nbsp;Rinku Sutradhar,&nbsp;Winnie Yu,&nbsp;Lucas B Chartier,&nbsp;Steven M Friedman,&nbsp;Megan Landes,&nbsp;Bjug Borgundvaag,&nbsp;Shelley L McLeod","doi":"10.9778/cmajo.20230017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Avoidance of care during the pandemic may have contributed to delays in care, and as a result, worse patient outcomes. We evaluated markers of illness acuity on presentation to the emergency department among patients with non-COVID-19-related emergent diagnoses and associated outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective study using linked administrative data from Ontario. We selected 4 emergent diagnoses, namely appendicitis, ectopic pregnancy, renal failure and diabetic ketoacidosis. We used the nonemergent diagnosis of cellulitis as a control. Our primary outcome of interest was hospital admission. Secondary outcomes were ambulance arrival, surgical intervention, subsequent hospital admission within 30 days of discharge from the emergency department or hospital and 30-day mortality. We compared outcomes during the first year of the COVID-19 pandemic (Mar. 15-Dec. 31, 2020) with a control period (Mar. 15-Dec. 31, 2018, and Mar. 15-Dec. 31, 2019).</p><p><strong>Results: </strong>Emergency department visits for all conditions initially decreased during the pandemic. During this period, patients across all study diagnoses were more likely to arrive to the emergency department via ambulance. Patients with an ectopic pregnancy had higher odds of surgery in the pandemic period (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) but this was not observed among patients with appendicitis. Patients with renal failure had increased odds of hospital admission (OR 1.14, 95% CI 1.04-1.24) and 30-day mortality (OR 1.17, 95% CI 1.04-1.31) during the pandemic period.</p><p><strong>Interpretation: </strong>The pandemic period was associated with increased arrival to the emergency department via ambulance across all study diagnoses. Although patients with renal failure had increased hospital admission and death, and patients with ectopic pregnancy had an increased risk of surgery, there were no differences in outcomes for other populations, suggesting the health care system was able to care for these patients effectively.</p>","PeriodicalId":93946,"journal":{"name":"CMAJ open","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/98/cmajo.20230017.PMC10609908.pdf","citationCount":"0","resultStr":"{\"title\":\"Hospital admission from the emergency department for selected emergent diagnoses during the first year of the COVID-19 pandemic in Ontario: a retrospective population-based study.\",\"authors\":\"Keerat Grewal,&nbsp;Clare L Atzema,&nbsp;Rinku Sutradhar,&nbsp;Winnie Yu,&nbsp;Lucas B Chartier,&nbsp;Steven M Friedman,&nbsp;Megan Landes,&nbsp;Bjug Borgundvaag,&nbsp;Shelley L McLeod\",\"doi\":\"10.9778/cmajo.20230017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Avoidance of care during the pandemic may have contributed to delays in care, and as a result, worse patient outcomes. We evaluated markers of illness acuity on presentation to the emergency department among patients with non-COVID-19-related emergent diagnoses and associated outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective study using linked administrative data from Ontario. We selected 4 emergent diagnoses, namely appendicitis, ectopic pregnancy, renal failure and diabetic ketoacidosis. We used the nonemergent diagnosis of cellulitis as a control. Our primary outcome of interest was hospital admission. Secondary outcomes were ambulance arrival, surgical intervention, subsequent hospital admission within 30 days of discharge from the emergency department or hospital and 30-day mortality. We compared outcomes during the first year of the COVID-19 pandemic (Mar. 15-Dec. 31, 2020) with a control period (Mar. 15-Dec. 31, 2018, and Mar. 15-Dec. 31, 2019).</p><p><strong>Results: </strong>Emergency department visits for all conditions initially decreased during the pandemic. During this period, patients across all study diagnoses were more likely to arrive to the emergency department via ambulance. Patients with an ectopic pregnancy had higher odds of surgery in the pandemic period (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) but this was not observed among patients with appendicitis. Patients with renal failure had increased odds of hospital admission (OR 1.14, 95% CI 1.04-1.24) and 30-day mortality (OR 1.17, 95% CI 1.04-1.31) during the pandemic period.</p><p><strong>Interpretation: </strong>The pandemic period was associated with increased arrival to the emergency department via ambulance across all study diagnoses. Although patients with renal failure had increased hospital admission and death, and patients with ectopic pregnancy had an increased risk of surgery, there were no differences in outcomes for other populations, suggesting the health care system was able to care for these patients effectively.</p>\",\"PeriodicalId\":93946,\"journal\":{\"name\":\"CMAJ open\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-10-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/98/cmajo.20230017.PMC10609908.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CMAJ open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.9778/cmajo.20230017\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/9/1 0:00:00\",\"PubModel\":\"Print\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CMAJ open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.9778/cmajo.20230017","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/9/1 0:00:00","PubModel":"Print","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

背景:在大流行期间避免护理可能导致护理延误,从而导致患者预后恶化。我们评估了非COVID-19相关紧急诊断和相关结果患者在急诊科就诊时的疾病敏锐度标志物。方法:我们使用安大略省的相关行政数据进行了一项回顾性研究。我们选择了4种紧急诊断,即阑尾炎、异位妊娠、肾功能衰竭和糖尿病酮症酸中毒。我们使用蜂窝组织炎的非紧急诊断作为对照。我们感兴趣的主要结果是住院。次要结果是救护车到达、手术干预、随后在急诊科或医院出院后30天内入院以及30天死亡率。我们比较了新冠肺炎大流行第一年(2020年3月15日至12月31日)与对照期(2018年3月15-12月31和2019年3月15-112月31)的结果。结果:在疫情期间,所有情况下的急诊就诊次数最初都有所减少。在此期间,所有研究诊断的患者更有可能通过救护车到达急诊室。异位妊娠患者在疫情期间手术的几率更高(比值比[OR]1.27,95%置信区间[CI]1.04-1.55),但在阑尾炎患者中没有观察到这一点。在疫情期间,肾衰竭患者入院的几率增加(OR 1.14,95%CI 1.04-1.24),30天死亡率增加(OR 1.17,95%CI 1.04-1.31)。解释:在所有研究诊断中,疫情期间通过救护车到达急诊室的人数增加。尽管肾功能衰竭患者入院和死亡人数增加,异位妊娠患者手术风险增加,但其他人群的结果没有差异,这表明医疗保健系统能够有效地照顾这些患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Hospital admission from the emergency department for selected emergent diagnoses during the first year of the COVID-19 pandemic in Ontario: a retrospective population-based study.

Hospital admission from the emergency department for selected emergent diagnoses during the first year of the COVID-19 pandemic in Ontario: a retrospective population-based study.

Hospital admission from the emergency department for selected emergent diagnoses during the first year of the COVID-19 pandemic in Ontario: a retrospective population-based study.

Hospital admission from the emergency department for selected emergent diagnoses during the first year of the COVID-19 pandemic in Ontario: a retrospective population-based study.

Background: Avoidance of care during the pandemic may have contributed to delays in care, and as a result, worse patient outcomes. We evaluated markers of illness acuity on presentation to the emergency department among patients with non-COVID-19-related emergent diagnoses and associated outcomes.

Methods: We conducted a retrospective study using linked administrative data from Ontario. We selected 4 emergent diagnoses, namely appendicitis, ectopic pregnancy, renal failure and diabetic ketoacidosis. We used the nonemergent diagnosis of cellulitis as a control. Our primary outcome of interest was hospital admission. Secondary outcomes were ambulance arrival, surgical intervention, subsequent hospital admission within 30 days of discharge from the emergency department or hospital and 30-day mortality. We compared outcomes during the first year of the COVID-19 pandemic (Mar. 15-Dec. 31, 2020) with a control period (Mar. 15-Dec. 31, 2018, and Mar. 15-Dec. 31, 2019).

Results: Emergency department visits for all conditions initially decreased during the pandemic. During this period, patients across all study diagnoses were more likely to arrive to the emergency department via ambulance. Patients with an ectopic pregnancy had higher odds of surgery in the pandemic period (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) but this was not observed among patients with appendicitis. Patients with renal failure had increased odds of hospital admission (OR 1.14, 95% CI 1.04-1.24) and 30-day mortality (OR 1.17, 95% CI 1.04-1.31) during the pandemic period.

Interpretation: The pandemic period was associated with increased arrival to the emergency department via ambulance across all study diagnoses. Although patients with renal failure had increased hospital admission and death, and patients with ectopic pregnancy had an increased risk of surgery, there were no differences in outcomes for other populations, suggesting the health care system was able to care for these patients effectively.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
5.40
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信