COVID-19 Pandemic’s Impact on Emergency Department’s Mortality

Abstract

Introduction: Official data shows increased excess all- -cause mortality in 2020 compared to 2019. Fear of exposure constrained medical evaluations which were delayed by either choice or imposition. Going to the emergency department (ED) was no exception. Our objective was to compare demographic, clinical and analytical characteristics of patients who died in a COVID-19 dedicated ED with the same period of 2019.

Material and Methods: Retrospective study analysing patient discharge notes who have died during ED permanence between March 18th and June 22nd of 2019 and in the same period of 2020. Statistical analysis was performed using IBM SPSS software.

Results: A total of 33 patients died in 2019 whereas 99 died in 2020 during the analysed period, representing a mortality rate of 0.34% and 1.89%, respectively. Only 4.04% (n = 4) of deceased patients tested positive for SARS-CoV-2 in 2020, while all showed severe respiratory infections. There was a statistically significant difference concerning length of stay in ED (p < 0.01), being bedridden (p = 0.04), dementia (p = 0.03) and presence of respiratory failure at admission (p = 0.001). There were no differences regarding demographic data, comorbidities, and other analytical parameters.

Conclusion: In 2020, deaths in the ED occurred among more vulnerable patients and with more severe disease. It was the later demand for hospital care, particularly in the worsening of chronic diseases, that irreversibly conditioned this outcome, especially in the context of chronic diseases exacerbation. Furthermore, the number of deaths that can be attributed to COVID-19 is negligible, deserving reflection and readaptation of good practices ensuring that patients are admitted to the ED within the recommended time and in accordance with the suspected pathologies.