Emergency Department Utilization for Emergency Conditions During COVID-19

Abstract

Study objective: We use a national emergency medicine clinical quality registry to describe recent trends in emergency department (ED) visitation overall and for select emergency conditions.

Methods: Data were drawn from the Clinical Emergency Department Registry, including 164 ED sites across 35 states participating in the registry with complete data from January 2019 through November 15, 2020. Overall ED visit counts, as well as specific emergency medical conditions identified by International Classification of Diseases, Tenth Revision, Clinical Modification code (myocardial infarction, cerebrovascular accident, cardiac arrest/ventricular fibrillation, and venous thromboembolisms), were tabulated. We plotted biweekly visit counts overall and across specific geographic regions.

Results: The largest declines in visit counts occurred early in the pandemic, with a nadir in April 46% lower than the 2019 monthly average. By November, overall ED visit counts had increased, but were 23% lower than prepandemic levels. The proportion of all ED visits that were for the select emergency conditions increased early in the pandemic; however, total visit counts for acute myocardial infarction and cerebrovascular disease have remained lower in 2020 compared with 2019. Despite considerable geographic and temporal variation in the trajectory of the coronavirus disease 2019 outbreak, the overall pattern of ED visits observed was similar across regions and time.

Conclusion: The persistent decline in ED visits for these time-sensitive emergency conditions raises the concern that coronavirus disease 2019 may continue to impede patients from seeking essential care. Efforts thus far to encourage individuals with concerning signs and symptoms to seek emergency care may not have been sufficient.

Figure 1

Total and select emergency condition biweekly ED visit counts. Data are drawn from the Clinical Emergency Department Registry, a sample of 164 EDs across 35 states. This includes the sum of overall ED visits, as well as summed emergency conditions including the following identified by Clinical Classification Software Revised code: myocardial infarction, cerebrovascular accident, cardiac arrest/ventricular fibrillation, and venous thromboembolism. Points are plotted together with smoothed fit curves generated by locally estimated scatterplot smoothing.

Figure 2

Total and summed select emergency condition biweekly ED visit counts, by region. Data are drawn from the Clinical Emergency Department Registry, a sample of 164 EDs across 35 states. This includes the sum of overall ED visits, as well as summed emergency conditions including the following identified by Clinical Classification Software Revised code: myocardial infarction, cerebrovascular accident, cardiac arrest/ventricular fibrillation, and venous thromboembolism. Points are plotted together with smoothed fit curves generated by locally estimated scatterplot smoothing.

Figure S1

Clinical Emergency Department Registry sites in the analysis sample.

Figure S2

COVID-19 outbreaks by active cases per 1,000 population, across regions.