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Observational Study
. 2022 Aug 9;19(16):9818.
doi: 10.3390/ijerph19169818.

Prevalence, Causes, and Adverse Clinical Impact of Delayed Presentation of Non-COVID-19-Related Emergencies during the COVID-19 Pandemic: Findings from a Multicenter Observational Study

Mohammed S Alshahrani  1   2 , Dunya Alfaraj  3 , Jehan AlHumaid  4 , Khalid Alshahrani  2 , Aisha Alsubaie  5 , Nasser Almulhim  6 , Dana Althawadi  5 , Salah Alam  5 , Malak Alzahrani  2 , Hassan Alwosibai  6 , Abdullah Alshahrani  3 , Rawan Makhdom  3 , Faisal Alkhadra  3 , Sukayna Al-Faraj  3 , Saad Al-Qahtani  7 , Amal AlSulaibikh  3 , Mohammed Al Jumaan  3 , Laila Perlas Asonto  3 , Sarah Alahmadi  3 , Mohannad Alghamdi  3 , Mohammed Al-Mulhim  3
Affiliations
Observational Study

Prevalence, Causes, and Adverse Clinical Impact of Delayed Presentation of Non-COVID-19-Related Emergencies during the COVID-19 Pandemic: Findings from a Multicenter Observational Study

Mohammed S Alshahrani et al. Int J Environ Res Public Health. .

Abstract

Objective: The coronavirus disease (COVID-19) pandemic has disrupted healthcare systems worldwide, resulting in decreased and delayed hospital visits of patients with non-COVID-19-related acute emergencies. We evaluated the impact of the COVID-19 pandemic on the presentation and outcomes of patients with non-COVID-19-related medical and surgical emergencies. Method: All non-COVID-19-related patients hospitalized through emergency departments in three tertiary care hospitals in Saudi Arabia and Bahrain in June and July 2020 were enrolled and categorized into delayed and non-delayed groups (presentation ≥/=24 or <24 h after onset of symptom). Primary outcome was the prevalence and cause of delayed presentation; secondary outcomes included comparative 28-day clinical outcomes (i.e., 28-day mortality, intensive care unit (ICU) admission, invasive mechanical ventilation, and acute surgical interventions). Mean, median, and IQR were used to calculate the primary outcomes and inferential statistics including chi-square/Fisher exact test, t-test where appropriate were used for comparisons. Stepwise multivariate regression analysis was performed to identify the factors associated with delay in seeking medical attention. Results: In total, 24,129 patients visited emergency departments during the study period, compared to 48,734 patients in the year 2019. Of the 256 hospitalized patients with non-COVID-19-related diagnoses, 134 (52%) had delayed presentation. Fear of COVID-19 and curfew-related restrictions represented 46 (34%) and 25 (19%) of the reasons for delay. The 28-day mortality rates were significantly higher among delayed patients vs. non-delayed patients (n = 14, 10.4% vs. n = 3, 2.5%, OR: 4.628 (CI: 1.296−16.520), p = 0.038). Conclusion: More than half of hospitalized patients with non-COVID-19-related diagnoses had delayed presentation to the ED where mortality was found to be significantly higher in this group. Fear of COVID-19 and curfew restrictions were the main reasons for delaying hospital visit.

Keywords: delayed presentation; emergency department; non-COVID-19 emergencies.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve of the probability of being alive at discharge among delayed and non-delayed patients based on the length of hospital stay.
See this image and copyright information in PMC

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