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Hospital Volumes of 5 Medical Emergencies in the COVID-19 Pandemic in 2 US Medical Centers

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Amid the coronavirus disease 2019 (COVID-19) pandemic, there have been anecdotal reports of a reduction in non–COVID-19 emergent diseases, including ischemic stroke1 and myocardial infarction (MI),2,3 and a general drop in emergency department volumes.4 The concern is that patients, wary of contact with individuals with COVID-19, are reluctant to seek care, even in the face of acute, life-threatening conditions. Using data from 2 academic medical centers, we assessed the association of the COVID-19 pandemic with the incidence of 5 medical emergencies: acute MI, ischemic stroke, nontraumatic subarachnoid hemorrhage (ntSAH), ectopic pregnancy, and appendicitis.

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Article Information

Accepted for Publication: July 2, 2020.

Published Online: October 26, 2020. doi:10.1001/jamainternmed.2020.3982

Corresponding Author: Melanie Hayden Gephart, MD, MAS, Brain Tumor Center, Department of Neurosurgery, Stanford University Medical Center, 300 Pasteur Dr, Palo Alto, CA 94305 (mghayden@stanford.edu).

Author Contributions: Mr Bhambhvani and Dr Hayden Gephart had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Bhambhvani, Rodrigues, Yu, Hayden Gephart.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Bhambhvani, Rodrigues, Yu.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Bhambhvani, Rodrigues, Yu.

Administrative, technical, or material support: Carr, Hayden Gephart.

Study supervision: Carr, Hayden Gephart.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Ryka Sehgal, BA (Weill Cornell Medical College), for support with protocol submission (no compensation), and Steven E. Flores, BS (Weill Cornell Medicine), for support with research informatics (no compensation).

References
1.
Morelli  N , Rota  E , Terracciano  C ,  et al.  The baffling case of ischemic stroke disappearance from the casualty department in the COVID-19 era.   Eur Neurol. 2020;83(2):213-215. doi:10.1159/000507666PubMedGoogle ScholarCrossref
2.
Krumholz  H . Where have all the heart attacks gone? New York Times. April 6, 2020. Accessed September 17, 2020. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html
3.
Solomon  MD , McNulty  EJ , Rana  JS ,  et al.  The Covid-19 pandemic and the incidence of acute myocardial infarction.   N Engl J Med. 2020;383:691-693. doi:10.1056/NEJMc2015630PubMedGoogle ScholarCrossref
4.
Wong  LE , Hawkins  JE , Langness  S , Murrell  KL , Iris  P , Sammann  A .  Where are all the patients? addressing Covid-19 fear to encourage sick patients to seek emergency care.   NEJM Catalyst. Published online May 14, 2020. doi:10.1056/CAT.20.0193Google Scholar
5.
Bernal  JL , Cummins  S , Gasparrini  A .  Interrupted time series regression for the evaluation of public health interventions: a tutorial.   Int J Epidemiol. 2017;46(1):348-355. doi:10.1093/ije/dyw098PubMedGoogle Scholar
6.
Griffin  S .  Covid-19: “huge rise” in deaths at home is not fully explained by virus, say experts.   BMJ. 2020;369:m2115. doi:10.1136/bmj.m2115PubMedGoogle ScholarCrossref
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