Sydney researchers have found “concerning reductions” in emergency department presentation numbers that may indicate delayed seeking of appropriate medical attention during the COVID-19 pandemic, they report in the Medical Journal of Australia today.

“COVID-19 has profoundly affected health care delivery,” wrote the researchers, led by Dr Andrew Kam, Senior Resident Medical Officer at Westmead Hospital.

“Equally concerning is the higher number mental health-related presentations, which may reflect anxiety about COVID-19, loss of job security, or prolonged isolation.”

Kam and colleagues analysed triage, International Classification of Diseases (10th revision), Australian modification (ICD-10-AM) coding, and separations data for emergency department (ED) presentations during 29 March – 31 May in each of 2019 and 2020 in the four hospitals with EDs in the Western Sydney Local Health District.

“The number of ED presentations during 29 March – 31 May was almost 25% lower in 2020 than in 2019 (26 617 v 35 268),” they found.

“Presentation numbers in all triage categories were lower in 2020, except for category 1 (resuscitation) (506 v 44). The proportion of patients discharged from the ED was greater in 2020 (60% v 53%) and that of patients who did not wait for treatment smaller (1% v 5%). The number of patients admitted to hospital was lower in 2020 than 2019 (8047 v 11 838), as were the proportions admitted to hospital (30% v 34%).

Kam and colleagues also looked at ED presentations with 14 selected diagnoses: common infectious diseases (infectious enteric disease, pneumonia), conditions frequently seen in EDs (wrist or hand fractures, femur fractures, appendicitis, renal calculi), conditions for which fewer ED presentations have been reported during COVID-19 restrictions overseas (stroke or cerebral haemorrhage, ACS, chest pain, transient ischaemic attacks), and conditions that may be exacerbated or for which follow-up in routine medical services may be reduced by COVID-19 and its associated restrictions (mental health problems, substance misuse, malignancy).

“The numbers of presentations with infectious enteric disease, pneumonia, wrist or hand fractures, stroke or intracerebral haemorrhage, and chest pain not resulting in another diagnosis were lower in 2020 than in 2019,” they found.

“The numbers of presentations with ACS were similar. The number of presentations with mental health problems was higher in 2020 (daily mean, 8.4) than in 2019 (daily mean, 6.9).

“Social distancing may have reduced the spread of infectious enteric diseases and community-acquired pneumonia, and home isolation may have led to fewer fractures,” they wrote.

“However, lower numbers of presentations with chest pain or stroke may reflect factors other than lower incidence, such as suspension of outpatient clinics and elective procedures, social distancing measures, and public anxiety.”

The researchers concluded that “public health messages should encourage timely presentation of people with time-sensitive, potentially life-threatening conditions, even during pandemics”.

“Studies of patients presenting to health care services as they re-open are required to fully appreciate the health implications of the COVID-19 epidemic.”