• David Gomez, Andrea N Simpson, Colin Sue-Chue-Lam, Charles de Mestral, Fahima Dossa, Jordan Nantais, Andrew S Wilton, David Urbach, Peter C Austin, and Nancy N Baxter.
• Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia David.gomez@unityhealth.to.
• CMAJ. 2021 May 25; 193 (21): E753E760E753-E760.

BackgroundReduced use of the emergency department during the COVID-19 pandemic may result in increased disease acuity when patients do seek health care services. We sought to evaluate emergency department visits for common abdominal and gynecologic conditions before and at the beginning of the pandemic to determine whether changes in emergency department attendance had serious consequences for patients.MethodsWe conducted a population-based analysis using administrative data to evaluate the weekly rate of emergency department visits pre-COVID-19 (Jan. 1-Mar. 10, 2020) and during the beginning of the COVID-19 pandemic (Mar. 11-June 30, 2020), compared with a historical control period (Jan. 1-July 1, 2019). All residents of Ontario, Canada, presenting to the emergency department with appendicitis, cholecystitis, ectopic pregnancy or miscarriage were included. We evaluated weekly incidence rate ratios (IRRs) of emergency department visits, management strategies and clinical outcomes.ResultsAcross all study periods, 39 691 emergency department visits met inclusion criteria (40.2 % appendicitis, 32.1% miscarriage, 21.3% cholecystitis, 6.4% ectopic pregnancy). Baseline characteristics of patients presenting to the emergency department did not vary across study periods. After an initial reduction in emergency department visits, presentations for cholecystitis and ectopic pregnancy quickly returned to expected levels. However, presentations for appendicitis and miscarriage showed sustained reductions (IRR 0.61-0.80), with 1087 and 984 fewer visits, respectively, after the start of the pandemic, relative to 2019. Management strategies, complications and mortality rates were similar across study periods for all conditions.InterpretationAlthough our study showed evidence of emergency department avoidance in Ontario during the first wave of the COVID-19 pandemic, no adverse consequences were evident. Emergency care and outcomes for patients were similar before and during the pandemic.© 2021 CMA Joule Inc. or its licensors.

44 keywords...

hide…