Emergency department visits, emergency severity index and intensive care unit admissions in the era of COVID19;A single center experience

Introduction: The purpose of triage in the Emergency Department (ED) is to prioritize incoming patients and to identify those who cannot wait to be seen (1) One of the most widely used triage tools is the Emergency Severity Index (ESI), which includes a five-level scale with ESI 1 describing a patient that requires immediate life-saving intervention/ resuscitation and ESI 5 a non-urgent patient (2) COVID19 has set new challenges in the organization and practice of emergency and critical care medicine, prompting for re-evaluation of existing tools Objectives: To assess the effects of the 'lockdown' on ED visits and the relationship between ESI 1 patients and short-term outcomes in the era of COVID19, in a tertiary Greek hospital Methods: ED data from Sismanoglio General Hospital, a tertiary Greek hospital in Athens metropolitan area, was retrospectively studied from 1/1/2020 to 30/6/2020 In Greece, a full 'lockdown' was imposed between 13/3/2020 and 4/5/2020 Results: The number of ED visits per month was significantly affected by 'lockdown' We noted 42 2% reduction in total ED visits during March-April compared to January-February and 41 7% compared to March-April 2019 After the 'lockdown' period a 24 1% increase in the number of ED visits was seen (Fig 1) Interestingly, the peak of epidemic in Greece did not influence ED attendances for immediate lifethreatening conditions (Fig 2) In our analysis patients assessed as ESI 1 constituted 0 46% of all ED patients for the 6-month period Furthermore, in the group of patients triaged to ESI 1, 20 8% died, 65 3% were admitted to the ICU and 13 9% were admitted to the ward None was discharged home from the ED (Fig 3) Conclusion: Our data is consistent with other reports of dramatic falls in ED attendances amid the outbreak of SARS-CoV-2, due to fear of contracting the disease (3,4) However, we noticed that individuals with critical illness (ESI 1) found their way to the ED at any given time during the coronavirus crisis From previous research we know that most ESI 1 patients are admitted to ICU, while some die in the ED (5,6) Our results show that during COVID19 crisis, ESI 1 was associated with high likelihood of ICU admission and death in the ED, suggesting that it remains a useful tool for predicting short-term outcomes of critically ill ED patients