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1.
PLoS One ; 15(10): e0239796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002074

RESUMO

Since the end of 2019, an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originating in the Chinese city of Wuhan has spread rapidly worldwide causing thousands of deaths. Coronavirus disease (COVID-19) is supported by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Italy has been the first European country recording an elevated number of infected forcing the Italian Government to call for total lockdown. The lockdown had the aim to limit the spread of infection through social distancing. The purpose of this study is to analyze how the pandemic has affected the patient's accesses to the Ophthalmological Emergency Department of a tertiary referral center in central-northern Italy, during the lockdown period. The charts of all patients that came to the Emergency Department during the lockdown period (March 10 -May 4, 2020) have been retrospectively collected and compared with those in the same period of 2019 and the period from 15 January- 9 March 2020. A significant reduction of visits during the lockdown has been observed, compared with those of pre-lockdown period (reduction of 65.4%) and with those of the same period of 2019 (reduction of 74.3%). Particularly, during the lockdown, minor and not urgency visits decreased whereas the undeferrable urgency ones increased. These pieces of evidence could be explained by the fear of patients to be infected; but also revealed patients misuse of emergency services.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Betacoronavirus , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Classificação Internacional de Doenças , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Adulto Jovem
2.
Medicina (Kaunas) ; 56(10)2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33019514

RESUMO

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February -31 March) in the last three years (2018-2019-2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência/tendências , Oftalmopatias/epidemiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Otorrinolaringopatias/epidemiologia , Admissão do Paciente/tendências , Estudos Retrospectivos , Doenças Torácicas/epidemiologia , Doenças Urológicas/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
3.
Ital J Pediatr ; 46(1): 142, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008445

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) is currently rare in children and they seem to have a milder disease course and better prognosis than adults. However, SARS-Cov-2 pandemic has indirectly caused problems in pediatric medical assistance. In view of this we wanted to draw a picture of what happened during health emergency and analyze future prospects for restarting. METHODS: We involved the Italian pediatric scientific societies institutionally collected in the Italian Federation of Associations and Scientific Societies of the Pediatric Area (FIARPED); We sent a questionnaire to all scientific societies about the pediatric care activity during the COVID-19 emergency and future perspectives for the phase of post-containment. RESULTS: The analysis of the questionnaires showed significant decrease of:admission, outpatient visits and specialist consultancy activities during the COVID-19 emergency, primarily linked to the fear of infection. Instead it was increased the serious degree of diseases admitted. Most of scientific societies maintained the relationship with chronic patients through some form of telemedicine, reporting a strong positive opinion about this modality. Finally showed the need to give life a new approach for hospitalizations and outpatient visits through a greater use of telemedicine, educational programs on families and a more decisive role of family pediatricians. CONCLUSIONS: Our study highlighted many aspects that can be improved in pediatric care. We think that It will be necessary a new shared strategy to improve the management and continuity of care for pediatric patients, primarily developing a network of collaboration between families, family pediatrician and hospitals and by enhancing the use of new methods of telecommunications.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/organização & administração , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Criança , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Pediatria/métodos , Pneumonia Viral/epidemiologia , Sociedades Médicas
4.
J Coll Physicians Surg Pak ; 30(9): 928-932, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33036676

RESUMO

OBJECTIVE: To investigate the association ​of white blood cell (WBC) counts, neutrophil, platelets, lymphocyte counts, C-reactive protein (CRP), neutrophil / lymphocyte ratio (NLR), derived NLR ratio (d-NLR), and platelet / lymphocyte ratio (PLR) at the time of first admission for mortality caused by COVID-19. STUDY DESIGN:  Descritive, analytical study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Sakarya University Training and Research Hospital, Turkey from  March 2020 to  May 2020. METHODOLOGY: One hundred and sixty-nine patients with the diagnosis of Covid-19 were retrospectively reviewed. Patients were divided into two groups as survivors and non-survivors. Inclusion criteria were age ≥18 years, RT-PCR test positivity, hospitalisation. Patients with missing data were excluded. Data regarding age, gender, WBC counts, neutrophil, platelets, and lymphocyte, CRP, NLR, d-NLR, PLR and comorbid conditions were analysed for mortality. All tests were done with a two-sided significance of 5%. For each endpoint, the absolute and relative effects and their corresponding 95% confidence interval  were calculated. RESULTS: There was a statistically significant association between neutrophil, lymphocyte, CRP, NLR, d-NLR and PLR values (p=0.005, p<0.001, p<0.001, p<0.001, p<0.001, and p<0.001, respectively) with mortality status of the patients. The cutoff values calculated by this analysis were 67.50 years for age, 5.12 K / µl for neutrophil, 1.12 K / µl for lymphocyte, 67.78 mg / dl for CRP, 3.9 for NLR, 2.55 for d-NLR, and 148.85 for PLR. CONCLUSION: Altered neutrophil and lymphocyte counts, NLR, d-NLR, PLR, and CRP values can be used as early predictors of mortality in Covid-19 patients. Key Words: Covid-19, Mortality, Emergency, NLR, d-NLR, PLR.


Assuntos
Infecções por Coronavirus/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Proteína C-Reativa/análise , Infecções por Coronavirus/sangue , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Pandemias , Contagem de Plaquetas , Pneumonia Viral/sangue
5.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Espanha/epidemiologia , Triagem/organização & administração
6.
Mayo Clin Proc ; 95(10): 2099-2109, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33012341

RESUMO

OBJECTIVE: To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication. METHODS: This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms at presentation to the emergency department were systematically read by electrophysiologists. The primary outcome was a composite of mechanical ventilation or death 48 hours from diagnosis. The prognostic value of ECG abnormalities was assessed in a model adjusted for demographics, comorbidities, and vital signs. RESULTS: At 48 hours, 73 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) patients dying by 30 days. Early development of respiratory failure was common, with 53% of all intubations occurring within 48 hours of presentation. In a multivariable logistic regression, atrial fibrillation/flutter (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 3.8) were associated with death or mechanical ventilation at 48 hours. In 108 patients without these ECG abnormalities and with normal respiratory vitals (rate <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities. CONCLUSION: The combination of abnormal respiratory vital signs and ECG findings of atrial fibrillation/flutter, right ventricular strain, or ST segment abnormalities accurately prognosticates early deterioration in patients with coronavirus disease 2019 and may assist with patient triage.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/fisiopatologia , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Betacoronavirus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico
7.
Dtsch Arztebl Int ; 117(33-34): 545-552, 2020 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-32865489

RESUMO

BACKGROUND: In this study, we investigate the number of emergency room consultations during the COVID-19 pandemic of 2020 in Germany compared to figures from the previous year. METHODS: Case numbers from calendar weeks 1 through 22 of the two consecutive years 2019 and 2020 were obtained from 29 university hospitals and 7 non-university hospitals in Germany. Information was also obtained on the patients' age, sex, and urgency, along with the type of case (outpatient/inpatient), admitting ward, and a small number of tracer diagnoses (I21, myocardial infarction; J44, COPD; and I61, I63, I64, G45, stroke /TIA), as well as on the number of COVID-19 cases and of tests performed for SARS-CoV-2, as a measure of the number of cases in which COVID-19 was suspected or at least included in the differential diagnoses. RESULTS: A total of 1 022 007 emergency room consultations were analyzed, of which 546 940 took place in 2019 and 475 067 in 2020. The number of consultations with a positive test for the COVID-19 pathogen was 3122. The total number of emergency room consultations in the observation period was 13% lower in 2020 than in 2019, with a maximum drop by 38% coinciding with the highest number of COVID-19 cases (calendar week 14; 572 cases). After the initiation of interpersonal contact restrictions in 2020, there was a marked drop in COVID-19 case numbers, by a mean of -240 cases per week per emergency room (95% confidence interval [-284; -128]). There was a rise in case numbers thereafter, by a mean of 17 patients per week [14; 19], and the number of cases of myocardial infarction returned fully to the level seen in 2019. CONCLUSION: In Germany, the COVID-19 pandemic led to a significant drop in medical emergencies of all kinds presenting to the nation's emergency departments. A recovery effect began to be seen as early as calendar week 15, but the levels seen in 2019 were not yet reached overall by calendar week 22; only the prevalence of myocardial infarction had renormalized by then. The reasons for this require further investigation.


Assuntos
Infecções por Coronavirus/epidemiologia , Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Alemanha/epidemiologia , Humanos
8.
Acta Biomed ; 91(3): e2020024, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921720

RESUMO

Coronavirus disease (COVID-19) is a systemic disease which can cause multiple organ failure and death primarly due to vascular endothelium injury. Severe acute respiratory distress syndrome (ARDS) is the main cause of death: its management and treatment should be tailored to the individual COVID-19 patient's phenotype. Early diagnosis of COVID-19 is paramount for disease treatment and infection control. Naso-pharyngeal (NP) swab is commonly used as screening and diagnostic tool for COVID-19, but in some cases it can be resulted negative even in presence of clinical and epidemiological criteria, and typical radiological and laboratory findings of COVID-19, as we have observed. Here we report our experience in the first month of the Italian epidemic. We strongly recommend clinicians to maintain a high index of suspicion for COVID-19, regardless of the persistence negativity of NP swabs, and not to delay the initiation of therapy in presence of typical clinical, radiological and laboratory findings of COVID-19.


Assuntos
Anticorpos Antivirais/análise , Betacoronavirus/imunologia , Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Nasofaringe/virologia , Pandemias , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Itália/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Fatores de Tempo
9.
Artigo em Inglês | MEDLINE | ID: mdl-32942698

RESUMO

This study outlines the impact of COVID-19 on paediatric emergency department (ED) utilisation and assesses the extent of healthcare avoidance during each stage of the public health response strategy. Records from five EDs and one urgent care centre in Ireland, representing approximately 48% of national annual public paediatric ED attendances, are analysed to determine changes in characteristics of attendance during the three month period following the first reported COVID-19 case in Ireland, with reference to specific national public health stages. ED attendance reduced by 27-62% across all categories of diagnosis in the Delay phase and remained significantly below prior year levels as the country began Phase One of Reopening, with an incident rate ratio (IRR) of 0.58. The decrease was predominantly attributable to reduced attendance for injury and viral/viral induced conditions resulting from changed living conditions imposed by the public health response. However, attendance for complex chronic conditions also reduced and had yet to return to pre-COVID levels as reopening began. Attendances referred by general practitioners (GPs) dropped by 13 percentage points in the Delay phase and remained at that level. While changes in living conditions explain much of the decrease in overall attendance and in GP referrals, reduced attendance for complex chronic conditions may indicate avoidance behaviour and continued surveillance is necessary.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde Pública , Betacoronavirus , Criança , Medicina Geral , Humanos , Irlanda , Pandemias , Encaminhamento e Consulta/estatística & dados numéricos
10.
Medicine (Baltimore) ; 99(38): e22289, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957386

RESUMO

The aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation-associated events and desaturation among these patients.Prospective observational cohort study conducted in an Academic pediatric tertiary emergency department. We compared 50 children intubated with Mcgrath Mac video laryngoscope (VL group) and an historical series of 141 children intubated with direct laryngoscopy (DL group). All patients were aged 1 to 18 years.The first attempt success rates were 68% (34/50) and 37.6% (53/141) in the VL and DL groups (P < .01), respectively. There was a lower proportion of tracheal intubation-associated events in the VL group (VL, 31.3% [15/50] vs DL, 67.8% [97/141]; P < .01) and no significant differences in desaturation (VL, 35% [14/50] vs DL 51.8% [72/141]; P = .06). The median number of attempts was 1 (range, 1-5) for the VL group and 2 (range, 1-8) for the DL group (P < .01). Multivariate logistic regression showed that video laryngoscope use was associated with higher chances of first-attempt intubation with an odds ratio of 4.5 (95% confidence interval, 1.9-10.4, P < 0.01).Compared with direct laryngoscopy, VL was associated with higher success rates of first-attempt tracheal intubations and lower rates of tracheal intubation-associated events.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscopia/instrumentação , Cirurgia Vídeoassistida/instrumentação , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Intubação Intratraqueal/estatística & dados numéricos , Laringoscopia/estatística & dados numéricos , Masculino , Estudos Prospectivos , Sistema de Registros , Cirurgia Vídeoassistida/estatística & dados numéricos
11.
Emerg Med J ; 37(10): 644-649, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32907844

RESUMO

The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. Lung ultrasound (LUS) has an established role in the evaluation of acute respiratory failure and has been used during the COVID-19 outbreak as a decision support tool. LUS shows characteristic changes in viral pneumonitis, and while these changes are not specific for COVID-19, it may be a useful adjunct during the diagnostic process. It is quick to perform and repeat and may be done at the bedside. The authors believe that LUS can help to mitigate uncertainty in undifferentiated patients with respiratory symptoms. This review aims to provide guidance regarding indications for LUS, describe the typical sonographic abnormalities seen in patients with COVID-19 and provide recommendations around the logistics of performing LUS on patients with COVID-19 and managing the infection control risk of the procedure. The risk of anchoring bias during a pandemic and the need to consider alternative pathologies are emphasised throughout this review. LUS may be a useful point-of-care test for emergency care providers during the current COVID-19 pandemic if used within a strict framework that governs education, quality assurance and proctored scanning protocols.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/epidemiologia , Índice de Gravidade de Doença , Ultrassonografia Doppler/estatística & dados numéricos , Reino Unido
12.
Emerg Med J ; 37(10): 600-604, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32948621

RESUMO

On 12 March 2020 the UK entered the 'delay phase' of the COVID-19 pandemic response. The Public Health England Emergency Department Syndromic Surveillance System (EDSSS) carries out daily (near real-time) public health surveillance of emergency department (ED) attendances across England. This retrospective observational analysis of EDSSS data aimed to describe changes in ED attendances during March-April 2020, and identify the attendance types with the largest impact. Type 1 ED attendances were selected from 109 EDs that reported data to EDSSS for the period 1 January 2019 to 26 April 2020. The daily numbers of attendances were plotted by age group and acuity of presentation. The 2020 'COVID-19' period (12 March 2020 to 26 April 2020) attendances were compared with the equivalent 2019 'pre-COVID-19' period (14 March 2019 to 28 April 2019): in total; by hour and day of the week; age group(<1, 1-4, 15-14, 15-44, 45-64 and 65+ years); gender; acuity; and for selected syndromic indicators(acute respiratory infection, gastroenteritis, myocardial ischaemia). Daily ED attendances up to 11 March 2020 showed regular trends, highest on a Monday and reduced in children during school holidays. From 12 March 2020 ED attendances decreased across all age groups, all acuity levels, on all days and times. Across age groups the greatest percentage reductions were seen in school age children (5-14 years). By acuity, the greatest reduction occurred in the less severe presentations. Syndromic indicators showed that the greatest reductions were in non-respiratory indicators, which fell by 44-67% during 2020 COVID-19, while acute respiratory infection was reduced by -4.4% (95% CI -9.5% to 0.6%). ED attendances in England have been particularly affected during the COVID-19 pandemic due to changes in healthcare seeking behaviour. EDSSS has enabled real-time daily monitoring of these changes, which are made publicly available to facilitate action. The EDSSS provides valuable surveillance of ED attendances in England. The flexibility of EDSSS allowed rapid development of new indicators (including COVID-19-like) and reporting methods.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Vigilância de Evento Sentinela , Síndrome Respiratória Aguda Grave/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/prevenção & controle , Reino Unido
13.
Emerg Med J ; 37(10): 630-636, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32948623

RESUMO

Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust's COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. An attempt was made to identify predictive elements for thromboembolism, cytokine storm and ARDS based on physiological measurements and blood tests, and to communicate to clinicians managing the patient, initially via single consultants. The input variables were age, sex, and first recorded blood pressure, respiratory rate, temperature, heart rate, indices of oxygenation and C-reactive protein. Early admissions were used to refine the predictors used in the traffic lights. Of 923 consecutive patients who tested COVID-19 positive, 592 (64%) flagged at risk for thromboembolism, 241/923 (26%) for cytokine storm and 361/923 (39%) for ARDS. Thromboembolism and cytokine storm flags were met in the ED for 342 (37.1%) patients. Of the 318 (34.5%) patients receiving thromboembolism flags, 49 (5.3% of all patients) were for suspected thromboembolism, 103 (11.1%) were high-risk and 166 (18.0%) were medium-risk. Of the 89 (9.6%) who received a cytokine storm flag from the ED, 18 (2.0% of all patients) were for suspected cytokine storm, 13 (1.4%) were high-risk and 58 (6.3%) were medium-risk. Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged.


Assuntos
Infecções por Coronavirus/terapia , Etiquetas de Emergência Médica/tendências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Tromboembolia/diagnóstico , Adulto , Fatores Etários , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Seleção de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Medicina de Precisão/estatística & dados numéricos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Tromboembolia/epidemiologia , Tromboembolia/terapia , Reino Unido
14.
Chirurgia (Bucur) ; 115(4): 486-492, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876022

RESUMO

Background: Burns are common reasons for emergency department presentations. While extensive or special burns require treatment in a specialized center, the majority are amenable to ambulatory treatment or hospitalization in a surgical ward. Romania has a national data collecting mechanism regarding all hospitalized patients, but there are no available statistics concerning non-hospitalized burn cases. This study aims to explore the amplitude of burn trauma by analyzing data from an Emergency Department at a major Romanian regional trauma center. Methods: This is a retrospective single-center 1-year study of all burn-related emergency department presentations at the trauma referral center for Romania's North-East region, in 2015. Included in the study were all cases of burns, indiscriminate of their etiology. Results: A total of 355 burn cases were analyzed. The average monthly number of cases was 29.58, with a maximum of 54 and a minimum of 18. There were 206 males and 149 females and 57.7% urban residents. Only 134 cases have been hospitalized during this period. Conclusions: Almost two-thirds of cases have not been hospitalized, thus missing from national statistics. Precise epidemiological data is paramount for a successful national burn management strategy. Creation of a national burn registry is suggested.


Assuntos
Queimaduras/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Unidades de Queimados/estatística & dados numéricos , Queimaduras/terapia , Feminino , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Romênia/epidemiologia , Resultado do Tratamento
15.
J Clin Virol ; 131: 104614, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32889495

RESUMO

BACKGROUND: Rapid sample-to-answer tests for detection of SARS-CoV-2 are emerging and data on their relative performance is urgently needed. OBJECTIVES: We evaluated the analytical performance of two rapid nucleic acid tests, Cepheid Xpert® Xpress SARS-CoV-2 and Mobidiag Novodiag® Covid-19, in comparison to a combination reference of three large-scale PCR tests. Moreover, utility of the Novodiag® test in tertiary care emergency departments was assessed. RESULTS: In the preliminary evaluation, analysis of 90 respiratory samples resulted in 100% specificity and sensitivity for Xpert®, whereas analysis of 107 samples resulted in 93.4% sensitivity and 100% specificity for Novodiag®. Rapid SARS-CoV-2 testing with Novodiag® was made available for four tertiary care emergency departments in Helsinki, Finland between 18 and 31 May, coinciding with a rapidly declining epidemic phase. Altogether 361 respiratory specimens, together with relevant clinical data, were analyzed with Novodiag® and reference tests: 355/361 of the specimens were negative with both methods, and 1/361 was positive in Novodiag® and negative by the reference method. Of the 5 remaining specimens, two were negative with Novodiag®, but positive with the reference method with late Ct values. On average, a test result using Novodiag® was available nearly 8 hours earlier than that obtained with the large-scale PCR tests. CONCLUSIONS: While the performance of novel sample-to-answer PCR tests need to be carefully evaluated, they may provide timely and reliable results in detection of SARS-CoV-2 and thus facilitate patient management including effective cohorting.


Assuntos
Infecções por Coronavirus/diagnóstico , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Pneumonia Viral/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Finlândia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Pandemias , Sensibilidade e Especificidade , Atenção Terciária à Saúde/estatística & dados numéricos , Adulto Jovem
16.
PLoS One ; 15(9): e0239801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970774

RESUMO

While hospital admissions for myocardial infarction (MI) and pulmonary embolism (PE) are decreased during the COVID-19 pandemic, controversy remains about respective complication and mortality rates. This study evaluated admission rates, complications, and intrahospital mortality for selected life-threatening cardiovascular emergencies (MI, PE, and acute aortic dissection (AAD)) during COVID-19-associated restrictive social measures (RM) in Styria, Austria. By screening a patient information system for International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis codes covering more than 85% of acute hospital admissions in the state of Styria (~1.24 million inhabitants), we retrospectively identified patients with admission diagnoses for MI (I21, I22), PE (I26), and AAD (I71). Rates of complications such as cardiogenic shock and cardiopulmonary resuscitation, treatment escalations (thrombolysis for PE), and mortality were analyzed by patient chart review during 6 weeks following onset of COVID-19 associated RM, and during respective time frames in the years 2016 to 2019. 1,668 patients were included. Cumulative admissions for MI, PE and AAD decreased (RR 0.77; p<0.001) during RM compared to previous years. In contrast, intrahospital mortality increased by 65% (RR 1.65; p = 0.041), mainly driven by mortality following MI (RR 1.80; p = 0.042). PE patients received more frequently thrombolysis treatment (RR 3.63; p = 0.006), while rates of cardiogenic shock and cardiopulmonary resuscitation remained unchanged. Of 226 patients hospitalized during RM, 81 patients with suspected COVID-19 disease were screened for SARS-CoV-2 infection with only 5 testing positive. Thus, cumulative hospital admissions for cardiovascular emergencies decreased during COVID-19 associated RM while intrahospital mortality increased.


Assuntos
Aneurisma Dissecante/mortalidade , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Pneumonia Viral/epidemiologia , Embolia Pulmonar/mortalidade , Idoso , Idoso de 80 Anos ou mais , Áustria , Betacoronavirus , Serviço Hospitalar de Emergência/tendências , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
17.
In Vivo ; 34(5): 3033-3038, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32871849

RESUMO

BACKGROUND/AIM: SARS-CoV-2 pandemic imposed extraordinary restriction measures and a complete reorganization of the Health System. The aim of the study was to evaluate the impact of COVID-19 on emergency surgical department accesses. PATIENTS AND METHODS: Patients admitted to surgical emergency departments was retrospectively recorded during the Lockdown (March 11, 2020-May 3, 2020) and compared with the same number of days in 2019 and immediately before Lockdown (January 16, 2020-March 10, 2020). Diagnoses, priority levels, modes of patient's transportation, waiting times and outcomes were analysed. RESULTS: During the lockdown phase, we ob-served a reduction in the access to emergency surgical departments of 84.45% and 79.78%, com-pared with the Pre-Lockdown2019 and Pre-Lockdown2020 groups, respectively. Patient's transportation, hospitalization and patients discharge with indications to an outpatient visit, waiting and total times exhibited a significant difference during the lockdown (p<0.005). CONCLUSION: We observed a reduction of surgical emergency accesses during the lockdown. Implementing the use of the regional systems and preventing overcrowding of emergency departments could be beneficial for reducing waiting times and improving the quality of treatments for patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Betacoronavirus/patogenicidade , Feminino , Planos de Sistemas de Saúde , Hospitalização , Humanos , Itália/epidemiologia , Masculino , Estudos Retrospectivos
19.
Artigo em Inglês | MEDLINE | ID: mdl-32906596

RESUMO

A critical point in the management of the SARS-CoV-2 pandemic is the need to promptly identify the greatest number of infected people and to implement strict public health measures. In this study, the performance of a rapid serological test in a clinical setting was evaluated. Samples from 819 consecutive patients (with or without respiratory symptoms) admitted to a large Emergency Department were tested between 23 March and 21 April 2020. Patient samples were tested in a real-time PCR assay and a serological assay. In total, 148/819 patients (18.1%) tested positive for SARS-CoV-2 by real-time PCR. The serological test revealed that 70/819 patients (8.5%) had anti-SARS-CoV-2 IgM and/or IgG. The prevalence of anti-SARS-CoV-2 antibodies was significantly higher in patients with respiratory symptoms lasting for >7 days than in those with respiratory symptoms lasting for 0-7 days (p < 0.001). The serological assay had an overall sensitivity of 35.1% and an overall specificity of 97.3%. A high negative predictive value (96.7%) was reported for patients without respiratory symptoms. The results confirm that rapid serological assays alone are not sufficient for diagnosis of SARS-CoV-2 infection but can be incorporated into large-scale screening programs during periods in which the virus circulation is low.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Pneumonia Viral/diagnóstico , Testes Sorológicos/métodos , Infecções por Coronavirus/epidemiologia , Humanos , Imunoglobulina G/sangue , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade
20.
Aust Health Rev ; 44(5): 741-747, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862832

RESUMO

Objective A pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. Methods A retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results A total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56-4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1-3.4, P<0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4-15.6, P<0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic? An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician's ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add? This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician's ability to complete primary consults. What are the implications for practitioners? When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Eficiência Organizacional/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Corpo Clínico Hospitalar/organização & administração , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Austrália , Betacoronavirus/patogenicidade , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Previsões , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Corpo Clínico Hospitalar/tendências , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Projetos Piloto , Estudos Retrospectivos
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