ORIGINAL ARTICLE   Free access

Panminerva Medica 2021 December;63(4):478-81

DOI: 10.23736/S0031-0808.20.04000-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Pattern of Emergency Department referral during the COVID-19 outbreak in Italy

Mattia BELLAN ^{1, 2, 3} ✉, Francesco GAVELLI ^{1, 3}, Eyal HAYDEN ^{1, 3}, Filippo PATRUCCO ¹, Daniele SODDU ^{1, 3}, Anita R. PEDRINELLI ^{1, 3}, Micol G. CITTONE ^{1, 3}, Eleonora RIZZI ^{1, 3}, Giuseppe F. CASCIARO ^{1, 3}, Veronica VASSIA ^{1, 3}, Raffaella LANDI ^{1, 3}, Mirta MENEGATTI ³, Maria L. GASTALDELLO ^{1, 3}, Michela BELTRAME ^{1, 3}, Emanuela LABELLA ^{1, 3}, Stelvio TONELLO ¹, Gian C. AVANZI ^{1, 3}, Mario PIRISI ^{1, 3}, Luigi M. CASTELLO ^{1, 3}, Pier P. SAINAGHI ^{1, 2, 3}

¹ Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; ² CAAD, Center for Autoimmune and Allergic Diseases, Novara, Italy; ³ Division of Internal and Emergency Medicine, Maggiore della Carità University Hospital, Novara, Italy

BACKGROUND: The Coronavirus disease (COVID-19) outbreak is putting the European National Health Systems under pressure. Interestingly, Emergency Department (ED) referrals for other reasons than COVID-19 seem to have declined steeply. In the present paper, we aimed to verify how the COVID-19 outbreak changed ED referral pattern.
METHODS: We retrospectively reviewed the clinical records of patients referred to the ED of a University Hospital in Northern Italy from 1 March to 13 April 2020. We compared the following data with those belonging to the same period in 2019: number of EDs accesses, rate of hospital admission, frequencies of the most common causes of ED referral, priority codes of access.
RESULTS: The number of ED referrals during the COVID-19 outbreak was markedly reduced when compared to the same period in 2019 (3059 vs. 5691; -46.3%). Conversely, the rate of hospital admission raised from 16.9% to 35.4% (P<0.0001), with a shift toward higher priority codes of ED admission. In 2020, we observed both a reduction of the number of patients referred for both traumatic (513, 16.8% vs. 1544, 27.1%; χ²=118.7, P<0.0001) and non-traumatic (4147 vs. 2546) conditions. Among the latter, suspected COVID-19 accounted for 1101 (43.2%) accesses.
CONCLUSIONS: The COVID-19 pandemic completely changed the pattern of ED referral in Italy, with a marked reduction of the accesses to the hospitals. This could be related to a limited exposure to traumas and to a common fear of being infected during EDs in-stay. This may limit the misuse of EDs for non-urgent conditions but may also delay proper referrals for urgent conditions.

KEY WORDS: Coronavirus; Emergencies; COVID-19; Emergency service, hospital