Emergency Department Utilization for Emergency Conditions During COVID-19

ABSTRACT Study Objective We utilize a national emergency medicine clinical quality registry to describe recent trends in 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 for specific emergency medical conditions identified by International Classification of Disease-10 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 pre-pandemic 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 to 2019. Despite considerable geographic and temporal variation in the trajectory of the COVID-19 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 COVID-19 may continue to impede patients from seeking essential care. Efforts thus far to encourage those with concerning signs and symptoms to seek out emergency care may not have been sufficient.