LAUSR

Study Objective: To evaluate whether the decrease in visits for ovarian and testicular torsion was less than the overall decrease in ED visits following the arrival of COVID-19 in the New York metropolitan area. There was a marked decrease in ED visits after COVID-19 arrived in the New York metropolitan area in the United States in early March 2020. This was likely due to public health mandates and fear of exposure to the virus. Because torsion of the ovaries or testes is usually heralded by sudden onset of severe pain, patients with these conditions may have overcome this general reluctance to go to the ED. We hypothesized that, following the arrival of COVID-19 in the New York metropolitan area, the decrease in torsion visits was less than the decrease in ED visits overall. 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 ED patients from March through November in 2019 and 2020. Data analysis: We tallied the number of patients diagnosed with ovarian or testicular torsion using the International Classification of Disease codes (version 10). We calculated the difference in the decrease in total visits compared to the decrease in torsion visits from 2019 to 2020, along with the 95% CI. Results: The database contained a total of 1,587,246 visits, 898,850 in 2019 and 688,396 in 2020 (a 23% decrease from 2019 to 2020). The number of patients diagnosed with torsion was 203 in 2019 and 185 in 2020 (a 9% decrease from 2019 to 2020). The median ages [IQRs] for ovarian and testicular torsion were: 28 [18-37] and 15 [13-19] years, respectively. The difference in the decrease in total visits compared to the decrease in torsion visits was 14% (95% CI:10% to 18%). Conclusions: Consistent with our hypothesis, we found that following the arrival of COVID-19 in the New York metropolitan area, the decrease in torsion visits was less than the overall decrease in ED visits. We speculate this difference was because of the sudden onset of severe pain associated with torsion. Additional studies are needed to determine if patients who have sudden onset of severe pain from other conditions had less of a decrease in visits than overall ED visits.