LAUSR

Study Objective: To assess the effect SARS-COVID-19 had on the distribution of diseases in the emergency department (ED) of a large academic center located in a region with low SARS-COVID-19 infection rates and deaths during the first peak of the pandemic. Methods: This is a cross-sectional observational study that collected data from every ED visit from March through June, 2019 and compared it to the same period in 2020. The main ICD-10 code associated with each visit was organized into 1 of 530 disease categories. The top 20 disease categories for 2019 were compared to 2020 to assess for any statistically significant variation in prevalence. Results: An unpaired T-test showed an increase in mean age from 2019 to 2020 (34.833 vs 37.978, P<.0001). A similar increase in age is noted when the data is divided into minors in 2019 vs 2020 (6.604 vs 6.939 P<.0002) but adults, 18 or older, show no statistically significant change in age. Mean Emergency Severity Index (ESI) decreased from 3.157 to 3.071 (P <.0001) using a T-test. There was a similar statistically significant decrease in ESI when the data was divided into minors in 2019 vs 2020 (3.419 vs 3.23 P<.0001) and adults in 2019 vs 2020 (3.044 vs 3.024 P<.002). A Z-Test showed a disproportionate decrease in the percentage of minorities coming to the ED from 2019 to 2020 (37.5% vs 36.6%, P<.0232). ED volume rates dropped by 52% in 2020. When comparing disease distribution for minors in 2019 vs 2020, a Z-Test found a statistically significant disproportionate decrease (P>.05) in the diseases under these categories: other specified upper respiratory infections, viral infection, abdominal pain and other digestive/abdomen signs and symptoms, otitis media, nausea and vomiting, intestinal infection, asthma, respiratory signs and symptoms, acute bronchitis, allergic reactions, skin and subcutaneous tissue infections. When comparing disease distribution for adults in 2019 vs 2020, a Z-Test found a statistically significant disproportionate decrease (P <.05) in diseases under these categories: Other specified upper respiratory infections, viral infection, abdominal pain and other digestive/abdomen signs and symptoms, otitis media, nausea and vomiting, intestinal infection, asthma, acute bronchitis Conclusion: National data shows that ED visits decreased significantly in 2020 compared to previous years with certain diseases or disease categories receiving a disproportionate decrease in prevalence. Data from this study shows a similar pattern of certain disease categories having disproportionate decreases in prevalence combined with increased acuity of patients presenting to the ED. While certain disproportionate decreases can be explained by mask mandates, social distancing, stay-at-home orders, and increased access to telemedicine, the authors of this study worry that fears around contracting SARS-COVID-19 kept patients from receiving needed medical care.