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Panminerva Medica 2020 Jun 16

DOI: 10.23736/S0031-0808.20.04000-8


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, Università del Piemonte Orientale UPO, Novara, Italy; 2 CAAD, Centre for Autoimmune and Allergic Diseases, Novara, Italy; 3 Internal Medicine and Emergency Medicine Divisions, “AOU Maggiore della Carità”, Novara, Italy


BACKGROUND: The coronavirus disease (COVID-19) outbreak is putting the European National Health Systems under pressure. Interestingly, Emergency Department (ED) referrals for reasons other 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 1st March to 13th 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 pandemic; emergency departments

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