Impact of the COVID-19 pandemic on emergency department visits: experience of a Brazilian reference center.

OBJECTIVE: To analyze the impact of COVID-19 on emergency department metrics at a large tertiary reference hospital in Brazil. METHODS: A retrospective analysis of consecutive emergency department visits, from January 1, 2020, to November 21, 2020, was performed and compared to the corresponding time frame in 2018 and 2019. The volume of visits and patients' demographic and clinic characteristics were compared. All medical conditions were included, except confirmed cases of COVID-19. RESULTS: A total of 138,138 emergency department visits occurred during the study period, with a statistically significant (p<0.01) reduction by 52% compared to both 2018 and 2019. This decrease was more pronounced for pediatric visits - a drop by 71% in comparison to previous years. Regarding clinical presentation, there was a decrease of severe cases by 34.7% and 37.6%, whereas mild cases decreased by 55.2% and 56.2% when comparing 2020 to 2018 and 2019, respectively. A 30% fall in the total volume of hospital admission from emergency department patients was observed during the study period, but accompanied by a proportional increase in monthly admission rates since April 2020. CONCLUSION: The COVID-19 pandemic led to a 52% fall in attendance at our emergency department for other conditions, along with a proportional increase in hospital admission rates of COVID-19 patients. Healthcare providers should raise patient awareness not to delay seeking medical treatment of severe conditions that require care at the emergency department.

Impact of the COVID-19 pandemic on emergency department visits: experience of a Brazilian reference center / Impacto da pandemia da COVID-19 no volume de atendimentos no pronto atendimento: experiência de um centro de referência no Brasil

ABSTRACT Objective To analyze the impact of COVID-19 on emergency department metrics at a large tertiary reference hospital in Brazil. Methods A retrospective analysis of consecutive emergency department visits, from January 1, 2020, to November 21, 2020, was performed and compared to the corresponding time frame in 2018 and 2019. The volume of visits and patients' demographic and clinic characteristics were compared. All medical conditions were included, except confirmed cases of COVID-19. Results A total of 138,138 emergency department visits occurred during the study period, with a statistically significant (p<0.01) reduction by 52% compared to both 2018 and 2019. This decrease was more pronounced for pediatric visits - a drop by 71% in comparison to previous years. Regarding clinical presentation, there was a decrease of severe cases by 34.7% and 37.6%, whereas mild cases decreased by 55.2% and 56.2% when comparing 2020 to 2018 and 2019, respectively. A 30% fall in the total volume of hospital admission from emergency department patients was observed during the study period, but accompanied by a proportional increase in monthly admission rates since April 2020. Conclusion The COVID-19 pandemic led to a 52% fall in attendance at our emergency department for other conditions, along with a proportional increase in hospital admission rates of COVID-19 patients. Healthcare providers should raise patient awareness not to delay seeking medical treatment of severe conditions that require care at the emergency department.

RESUMO Objetivo Analisar o impacto da pandemia da COVID-19 nas métricas do pronto atendimento de um hospital terciário de referência no Brasil. Métodos Uma análise retrospectiva das visitas consecutivas ao pronto atendimento, de 1o de janeiro de 2020 a 21 de novembro de 2020, foi realizada e comparada ao mesmo intervalo nos anos de 2018 e 2019. O volume de atendimentos e as características clínicas e demográficas dos pacientes foram comparados. Todos os diagnósticos foram incluídos, exceto os casos confirmados de COVID-19. Resultados Um total de 138.138 visitas ao pronto atendimento ocorreu durante o período do estudo, com redução estatisticamente significativa (p<0,01) de 52% do volume comparado tanto a 2018 como a 2019. Essa queda foi mais pronunciada nos atendimentos de pediatria, com redução de 71% se comparada aos números de anos anteriores. Em relação ao quadro clínico, houve redução dos casos graves em 34,7% e 37,6%, enquanto os casos leves caíram 55,2% e 56,2%, quando comparado 2020 a 2018 e a 2019, respectivamente. Uma queda de 30% foi vista no volume de admissões hospitalares originadas dessas visitas, porém houve aumento percentual da taxa de admissão mensal em relação ao volume desde abril de 2020. Conclusão O impacto da pandemia da COVID-19 gerou redução de 52% no volume de atendimento do pronto atendimento por outras condições clínicas, bem como aumento proporcional na taxa de admissão hospitalar de pacientes com COVID-19. Os profissionais de saúde devem orientar seus pacientes a não atrasar a procura por atendimento médico de condições graves que precisem de cuidados no pronto atendimento.

Posição Prona em pacientes cardiopatas: revisão da literatura / La posición Prona en pacientes con cardiopatías: encuesta sobre la literatura / The Prone position in cardiophatic patients: a literature survey

A posição prona parece ser uma estratégia promissora para melhorar a hipoxemia em pacientes com lesão pulmonar aguda e síndrome do desconforto respiratório agudo. Estudos realizados têm demonstrado que, durante sua aplicação, ocorre a ventilação de áreas previamente atelectasiadas, o que se acompanha de redistribuição do fluxo sanguíneo, com redução do shunt intrapulmonar e conseqüente melhora na relação ventilação/perfusão. Os autores fazem uma revisão sobre o uso da posição prona, suas indicações e contra-indicações, bem como os mecanismos envolvidos na melhora da oxigenação de pacientes cardiopatas.

The prone position seems to be a promising strategy to improve hypoxemia in patients with acute pulmonary injuries and acute respiratory discomfort syndrome. Studies have shown that, during its application, the ventilation of areas previously atelectasied occurs and is followed by blood flow redistribution with a reduction of intrapulmonary shunt, causing an improvement in the ventilation/perfusion relationship. The authors made a survey on the use of the prone position, its indications and contraindications, as well as the mechanisms involved in the improvement of the oxygenation of cardiopathic patients.

La posición Prona parece ser una estrategia prometedora para mejorar la hipoxemia en pacientes con lesiones pulmonares agudas y síndrome de dificultad respiratoria aguda. Los estudios han demostrado que, durante su uso, ocurre la ventilación de áreas previamente atelectasiadas, seguida por la redistribución del flujo de la sangre con una reducción de la desviación intrapulmonaria, causando una mejora en la relación ventilación/perfusión. Los autores hicieron un examen del uso de la posición prona, de sus indicaciones y contraindicaciones, así bien los mecanismos implicados en la mejora de la oxigenación de pacientes con cardiopatías.