Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on Emergency Patients Hospitalized With Cardiocerebrovascular Diseases in Osaka Prefecture, Japan　- A Population-Based Study.

BACKGROUND: Little is known about the transport and outcomes of emergency patients with cardiocerebrovascular diseases in Japan before and during the COVID-19 pandemic.Methods and Results: Data were extracted from a population-based registry in Osaka, Japan, from 2019 to 2021. There were almost no differences in the numbers of emergency patients hospitalized with myocardial infarction, stroke, or heart failure or their deaths. However, the number of cases of difficulty obtaining patient acceptance by hospitals increased in 2020 and 2021 compared with 2019. CONCLUSIONS: The numbers of emergency patients hospitalized with cardiocerebrovascular diseases and their deaths in Osaka were not affected by the COVID-19 epidemic.

Effect of the COVID-19 outbreak on emergency transport of children by an emergency medical service system: a population-based, ORION registry study.

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2, has spread rapidly around the world. OBJECTIVE: To assess the effect of the COVID-19 pandemic on the emergency medical service (EMS) and hospital admission course for children transported by ambulance. METHODS: This study was a retrospective, descriptive study with a study period from January 1, 2018 to December 31, 2020 using the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. All children who were transported by ambulance in Osaka Prefecture were included. The main outcome of this study was the rate of difficult-to-transfer cases, which was calculated by univariate and multivariate Poisson regression analyses. RESULTS: Over the 3 years between January 1, 2018 and December 31 2020, 1,436,212 patients were transported to hospitals by ambulances in Osaka Prefecture, with children accounting for 102,473 (37,064, 39,590, and 25,819, in 2018, 2019, and 2020, respectively). Poisson regression analysis showed that children were negatively associated with difficult-to-transfer cases (risk ratio (RR) 0.35, 95% CI 0.33 to 0.37). With reference to 2018, 2020 was not significantly associated with difficult-to-transfer cases in children (RR 1.14, 95% CI 0.99 to 1.32, P = 0.075), but was significantly related (RR 1.24, 95% CI 1.21 to 1.27, P < 0.001) to difficult-to-transfer cases in the general population. CONCLUSION: Children were consistently associated with a reduced RR for difficult-to-transfer cases, even in the COVID-19 pandemic in 2020.

Factors associated with prolonged duration of viral clearance in non-severe SARS-CoV-2 patients in Osaka, Japan.

BACKGROUND: We investigated factors associated with prolonged viral clearance of SARS-CoV-2 among non-severe adult patients in Osaka, Japan. A total of 706 laboratory-confirmed COVID-19 patients were enrolled in this longitudinal observational study between 29 January 2020 and 31 May 2020, across 62 hospitals and three non-hospital recuperation facilities. METHODS: Logistic regression analysis was performed to investigate the factors associated with prolonged (29 days: upper 25% in duration) viral clearance of SARS-CoV-2. Linear regression analysis was conducted to assess these factors 14 days after symptom onset. RESULTS: The median duration of viral clearance was 22 days from symptom onset. After adjustment for sex, age, symptoms, comorbidity, and location of recuperation, comorbidities were associated with prolonged duration: (OR, 1.77 [95% CI, 1.11-2.82]) for one, (OR, 2.47 [95% CI, 1.32-4.61]) for two or more comorbidities. Viral clearance 14 days after symptom onset was 3 days longer for one comorbidity and 4 days longer for two or more comorbidities compared to clearance when there was no comorbidity. CONCLUSION: The presence of comorbidity was a robust factor associated with a longer duration of viral clearance, extending by 3 to 4 days compared to patients with no comorbidity.

[A Case of Transverse Colon Cancer in Which Long-Term Chemotherapy Was Performed after Palliative Colonic Stent Placement].

We report a case involving a 76-year-old woman with transverse colon cancer undergoing long-term chemotherapy following palliative colonic stent placement. She visited our hospital with a diagnosis of colonic obstruction. Her abdomen was evidently distended and tender. CT revealed the apple core sign in the transverse colon-hepatic flexure area, and then bowel obstruction. The disseminated lesion occluded the superior mesenteric vein. Multiple masses were found on both lungs; a single tumor was detected in liver S6. Hence, we diagnosed her with unresectable obstructive transverse colon cancer. A colonic stent was inserted to remove the obstruction. Because primary tumor resection was rendered impossible, mFOLFOX6 was initiated with the colonic stent intact. After 5 courses, CT revealed that the liver metastasis disappeared, and lung metastases exhibited SD of a therapeutic effect. She further received 5 courses of mFOLFOX6 and 20 courses of maintenance therapy using FU. However, single liver metastasis recurred, exhibiting PD of a therapeutic effect. Histological diagnosis of liver metastasis was a consistent finding due to metastatic colorectal cancer; RAS mutation was not detected. Currently, 2 years after the diagnosis, FOLFIRI and panitumumab are being administered as the second-line treatment, with no colonic stentrelated complications.

Impact of coronavirus disease 2019 on the mortality of patients who received emergency transportation: a population-based cross-sectional study.

Aim: The spread of coronavirus disease 2019 (COVID-19) has a widespread impact on emergency medical care systems. However, its effects on the mortality of emergency transportation patients are unclear. This population-based, cross-sectional study investigated how COVID-19 impacted the mortality and outcomes of emergency transportation patients. Methods: We compared mortality in the emergency department and at day 21 after an emergency visit for patients transported by ambulance to medical facilities in the Osaka Prefecture, Japan, between January 29 and December 31, 2020 (first pandemic year) and between January 29 and December 31, 2019 (immediate pre-pandemic year; 804,718 patients in total), using multivariable analysis to adjust for potential confounders. Results: During the first pandemic year, 50,446 fewer patients received emergency transportation compared with the immediate prepandemic year. Emergency department deaths increased by 603 during the first pandemic year (4,922 versus 4,319 deaths) and 640 within 21 days (14,569 versus 13,929 deaths). Multivariable analysis revealed an association between the first pandemic year and increased mortality rates among patients given emergency transportation compared with the immediate prepandemic year (odds ratio for emergency department deaths 1.31; 95% confidence interval 1.26-1.38; odds ratio for deaths within 21 days 1.17; 95% confidence interval 1.14-1.20). Conclusions: The study results indicate that the spread of COVID-19 impacted the mortality of patients who received emergency transportation. Further studies are expected to clarify the impact of COVID-19 on emergency medical care systems.

Epidemiology of patients with dizziness over a 3-year period, requiring utilization of the emergency medical serviced system: A pre- and post-COVID pandemic comparative study using the population-based ORION registry.

OBJECTIVE: We aimed to identify the proportion of each medical condition or disease contributing to dizziness and their disposition in the Emergency Department (ED). METHODS: This retrospective, descriptive study examined data from the Osaka Emergency Information Research Intelligent Operation Network system in Japan for the period from January 1, 2018 to December 31, 2020. The inclusion criteria were patients with presumptive ICD-10 codes including "dizziness" or "vertigo". Patient demographics were compared using the χ2 test and Kruskal-Wallis test. Logistic regression analysis was performed to calculate disposition from ED (emergency admission or discharge) over the 3-year study period. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using multivariate analyses. RESULTS: During the 3-year study period, a total of 1,346,457 patients (462,773 in 2018, 468,697 in 2019, and 414,987 in 2020; P < 0.001), including 53,190 patients with dizziness (18,396 in 2018, 18,649 in 2019, and 16,145 in 2020; P = 0.058), were identified as having been transported to hospitals by ambulance in Osaka Prefecture. Dizziness and giddiness (R42) was the most common form of dizziness, in 27,075 cases (9,570 in 2018, 9,613 in 2019, and 7,892 in 2020; P < 0.001; Gender composition showed 10,483 males and 16,592 females.) Vestibular Neuronitis (H81.2) showed significant increase in 2020 compared to the two preceding years (91 in 2018, 119 in 2019, and 130 in 2020, P = 0.003; including 174 males and 167 females, respectively). Of the 53,190 patients with dizziness, 11,862 (22.3%; 4,323 males, 7,539 females) were admitted to hospital. The odds ratio (OR) for emergency admission for dizziness in 2020 during the COVID-19 pandemic was 0.98 (95% confidence interval (CI), 0.93- 1.03) with reference to 2018. CONCLUSION: Patients with dizziness accounted approximately 4% of ED transportations, with about 20% requiring hospital admission, irrespective of the COVID-19 pandemic. Vestibular neuronitis was significantly increased in 2020.

Assessing the impact of COVID-19 pandemic on ambulance transports for self-harm: a population-based study in Osaka Prefecture, Japan.

OBJECTIVES: The COVID-19 pandemic might have affected emergency medical services transports for self-harm in Japan. However, the available data are insufficient to fully understand the pandemic's impact on ambulance transports due to self-harm. This study aimed to investigate the change in the incidence of ambulance transports for self-harm from 2018 to 2021 and to identify vulnerable age groups during the pandemic. DESIGN: A population-based observational study using a database from the Osaka Prefectural Government. SETTING: The database covers the entire area of Osaka Prefecture and included information on ambulance transports and hospital details. PARTICIPANTS: Ambulance transport of patients due to self-harm from 2018 through 2021 was investigated. PRIMARY OUTCOME MEASURES: The primary outcome was the incidence of ambulance transport for self-harm. RESULTS: We analysed 10 843 patients. Their median age was 38 years, and 69.0% were female. We observed an increasing trend of the incidence rate in cases per 100 000 population per year from 29.4 in 2018 to 31.2 in 2021. However, after adjusting for age group, sex and month, there was no difference in the incidence of ambulance transport due to self-harm in 2019 (adjusted incidence rate ratio (aIRR) 1.007; 95% CI 0.955 to 1.063), 2020 (aIRR 1.041; 95% CI 0.987 to 1.098) and 2021 (aIRR 1.022; 95% CI 0.968 to 1.078), compared with 2018. We observed no difference in 21-day mortality from 2018 through 2021. In the age group of 20-29 years, despite no difference in 2019 compared with 2018, we found an 11.7% increase in the incidence of ambulance transport due to self-harm in 2020 (aIRR 1.117; 95% CI 1.002 to 1.245) and no difference in 2021. CONCLUSIONS: There was no difference in the incidence of ambulance transport due to self-harm and 21-day mortality from 2018 through 2021. However, the incidence rate of ambulance transport due to self-harm in 2020 increased in the age group of 20-29 years.

Incidence and outcome of patients with difficulty in hospital acceptance during COVID-19 pandemic in Osaka Prefecture, Japan: A population-based descriptive study.

Aim: The impact of the coronavirus disease (COVID-19) pandemic on the emergency medical service system in Japan has not been fully revealed. The purpose of this study was to determine the impact of the COVID-19 pandemic in 2021 on the difficulty in hospital acceptance of patients and patient outcome in Osaka Prefecture. Methods: This study was a descriptive epidemiological study with a 3-year study period from January 2019 to December 2021. We included patients who were transported by ambulance and had registered in the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. The primary end-point of this study was the difficulty in hospital acceptance by month, and the secondary outcome was the mortality of patients who experience difficulty in hospital acceptance in each year. Results: We included 1,302,646 cases in this study. The proportion of cases with difficulty in hospital acceptance was 2.74% (12,829/468,709) in 2019, 3.74% (15,527/414,987) in 2020, and 5.09% (21,311/418,950) in 2021. The crude odds ratio for 2020 was 1.38 (95% confidence interval, 1.35-1.41) and for 2021 was 1.90 (95% confidence interval, 1.86-1.95). In 2019, 218 patients with difficulty in hospital acceptance had died by 21 days after hospitalization, whereas the number increased to 405 in 2020 and 750 in 2021. Conclusion: The number of patients experiencing difficulty in hospital acceptance during the COVID-19 pandemic in Osaka Prefecture increased, and patient outcomes were worse than before the pandemic.

Outcome of emergency patients transported by ambulance during the COVID-19 pandemic in Osaka Prefecture, Japan: a population-based descriptive study.

Background: The novel corona virus (COVID-19) pandemic occurred worldwide. Although an excessive burden was placed on emergency medical institutions treating urgent and severe patients, its impact on patient outcome remains unknown. This study aimed to assess the impact of the COVID-19 pandemic in 2021 on the emergency medical services (EMS) system and patient outcomes in Osaka Prefecture, Japan. Methods: This was a retrospective descriptive study with a study period from January 1, 2019 to December 31, 2021. We included patients who were transported by ambulance and had cleaned data that was recorded in the ORION system. The study endpoints were the number of patients transported by ambulance and the number of deaths among these patients in each month. To assess the impact of the COVID-19 pandemic on the EMS system, the incidence rate ratio (IRR) and 95% confidence interval (CI) were calculated using 2019 as the reference year. Mortalities were evaluated based on deaths in the emergency department and deaths at 21 days after hospitalization. Results: The numbers of patients transported by ambulance were 500,194 in 2019, 443,321 in 2020 (IRR: 0.88, 95% CI: 0.87-0.88), and 448,054 in 2021 (IRR: 0.90, 95% CI: 0.89-0.90). In 2019, the number of patients transported by ambulance and who died in the emergency departments was 4,980, compared to 5,485 in 2020 (IRR: 1.10, 95% CI; 1.06-1.44) and 5,925 in 2021 (IRR: 1.19, 95% CI: 1.15-1.24). In 2019, the number of patients who died within 21 days after hospitalization was 11,931, compared to 11,913 in 2020 (IRR; 1.00, 95% CI; 0.98-1.03) and 13,376 in 2021 (IRR; 1.12, 95% CI; 1.09-1.15). Conclusion: The COVID-19 pandemic decreased the number of ambulance requests and worsened mortality of patients transported by ambulance in Osaka Prefecture during 2021.

Influence of the COVID-19 outbreak on transportation of pregnant women in an emergency medical service system: Population-based, ORION registry.

BACKGROUND: The coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2, has spread rapidly across the world. OBJECTIVE: To assess the influence of the COVID-19 pandemic on the emergency medical service (EMS) for transportation of pregnant women by ambulance. METHODS: This study was a retrospective, descriptive study using the Osaka Emergency Information Research Intelligent Operation Network system, and included pregnant women transported by ambulance in Osaka Prefecture between January 1, 2018 and December 31, 2020. The main outcome of the study was difficulty in obtaining hospital acceptance for transfer of patients (difficult-to-transfer cases). We calculated the rates of difficult-to-transfer cases using univariate and multivariate analyses. RESULTS: Of the 1 346 457 total patients transported to hospitals by ambulance in Osaka Prefecture during the study period, pregnant women accounted for 2586 (909, 943, and 734, in 2018, 2019, and 2020, respectively). Logistic regression analysis revealed that pregnant women were negatively associated with difficult-to-transfer cases (adjusted OR 0.36, 95% CI 0.26-0.50). Compared with 2018, 2020 was significantly associated with difficult-to-transfer cases (adjusted OR 1.27, 95% CI 1.24-1.30). CONCLUSION: Pregnant women were consistently associated with reduced odds for being difficult-to-transfer cases. The COVID-19 pandemic might have influenced difficult-to-transfer cases in 2020.

The characteristics and clinical course of patients with COVID-19 who received invasive mechanical ventilation in Osaka, Japan.

OBJECTIVE: To describe the detailed clinical course of patients with coronavirus disease 2019 (COVID-19) who received invasive mechanical ventilation. METHODS: We conducted a case series of patients with COVID-19 who received invasive mechanical ventilation in Osaka, Japan, between January 29 and May 28, 2020. We describe the patient characteristics and clinical course from onset. Additionally, we fitted logistic regression models to investigate the associations between patient characteristics and the 30-day mortality rate. RESULTS: A total of 125 patients who received invasive mechanical ventilation (median age [interquartile range], 68 [57-73] years; male, 77.6%) were enrolled. Overall, the 30-day mortality was 24.0%, and the median (interquartile range) length of ICU stay and length of invasive mechanical ventilation use were 16 (12-29) days and 13 (9-26) days, respectively. From clinical onset, 121 patients (96.8%) were intubated within 14 days. In multivariable logistic regression analysis, age of 65 years or older (odds ratio, 3.56; 95% confidence interval, 1.21-10.49; P = 0.02) and male sex (odds ratio, 3.75; 95% confidence interval, 1.00-11.24, P = 0.04) were significantly associated with a higher 30-day mortality rate. CONCLUSIONS: In this case series of patients with COVID-19 who received invasive mechanical ventilation in Japan, the 30-day mortality rate was 24.0%, and age 65 years or older and male sex were associated with higher 30-day mortality rate.

Characteristics and outcome of patients triaged by telephone and transported by ambulance: a population-based study in Osaka, Japan.

AIM: Details such as diagnosis and outcome of patients transported by ambulance after telephone triage have not been fully revealed. The aim of this study was to reveal profile and outcome about patients transported by ambulance via telephone triage with dataset of telephone triage and population-based registry for emergency patients. METHODS: This retrospective descriptive study with a one-year study period from January 1, 2016 to December 31, 2016 included patients selected from the telephone triage dataset who were transported by ambulance. Key parameters such as age, sex and date and time of ambulance dispatch were used to identify patient data from the ORION registry. We assessed the profile and outcome of the patients in a descriptive epidemiological analysis. RESULTS: We included 4,293 patients in the selected datasets whose data were merged, of whom 2,998 patients (69.8%) returned home from the emergency department, 1,255 (29.2%) were hospitalized, 32 (0.7%) were transferred to other hospitals, and 8 (0.2%) died. The most common diagnosis in the emergency departments was "infectious gastroenteritis and colitis, unspecified [A09] (219, 5.1%)". Among the 1,255 hospitalized patients, 905 patients (72.1%) were discharged home, 254 patients (20.2%) remained hospitalized, 52 patients (4.1%) were transferred to other hospitals, 38 patients (3.0%) died, and 5 patients (0.5%) had missing data. The most common diagnosis was "cerebral infarction [I63.0-I63.9] (138, 11.0%)". CONCLUSION: This study revealed the profile and outcome of patients transported by ambulance after telephone triage.