LAUSR

Study Objectives: COVID-19 infection has been shown to be associated with increased numbers of pulmonary embolisms (PE) and deep venous thromboses (DVT). COVID-19 arrived in the New York City area in early March 2020. We hypothesized that the number of ED patients diagnosed with PEs and DVTs increased after the arrival of Covid- 19. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching or non-teaching and rural, suburban or urban. Annual ED volumes were from 12, 000 to 122, 000. Population: Consecutive patients seen by ED physicians from March through November in 2019 and 2020, as COVID-19 arrived in this region in early March. Data analysis: We tallied the number of patients diagnosed with PEs and DVTs using International Classification of Disease (version 10) codes. We computed the changes in visits from 2019 to 2020. We used chi-square to test for statistical significance, with alpha set at 0.025using the Bonferroni correction for multiple comparisons. Results: The database contained a total of 1, 975, 332 visits, 1, 161, 080 in 2019 and 814, 252 in 2020 (a 30% decrease from 2019 to 2020). There were 3, 552 and 2, 529 patients diagnosed with PE and DVT respectively. The median age [interquartile range] and the percent female for PE and DVT were: 62 [48-72] and 62 [49-74];52% and 50% respectively. The number of visits for PE from March through November in 2019 and 2020 were 1349 and 1180, respectively. For DVTs these numbers were 1, 977 and 1, 575. Thus, visits for PE and DVT decreased from 2019 to 2020 by 20% and 13% respectively (p <0.001). Conclusion: Contrary to our hypothesis, we found that after the arrival of COVID-19 in the New York City area, visits for PEs and DVTs did not increase. We speculate that ED visits in 2020 decreased due to public fears of exposure to COVID-19 infection during hospital visits. Furthermore, testing for diagnosis of PE and DVT was often deferred because of the challenges in performing these studies on patients under investigation for COVID-19 infection. These factors could explain the decrease in number of PE and DVT cases that we found, despite the possible increased incidence of these conditions in the population.