Impact of First Wave of COVID-19 Pandemic on Mortality at Emergency Department in Older Patients with COVID and Non-COVID Diagnoses
Authors: Fernández Alonso Cesáreo , Fuentes Ferrer Manuel , Llorens Pere , Burillo Guillermo , Alquézar-Arbé Aitor , Jacob Javier , Montero-Pérez F. Javier , Aguiló Sira , Abad Cuñado Vanesa , Amer Al Arud Lilia , Escudero Sánchez Carmen , Poch Ferret Eduard Anton , Hong Cho Jeong-Uh , Escolar Martínez-Berganza María Teresa , Gayoso Martín Sara , Sánchez Sindín Goretti , Prieto Zapico Azucena , Petrus Rivas María Carmen , Doi Grande Adriana Laura , Llauger Lluís , Rodríguez Valles Celia , Marquez Quero Laura , Juárez González Ricardo , Ruescas Esther , Fernández Salgado Fátima , Ríos Gallardo Rafaela , de Juan Gómez María Ángeles , Masid Barco Marta , González del Castillo Juan , Miró Òscar ,   on behalf of the members of the SIESTA network
Published: December 2023

<b><i>Introduction:</i></b> Mortality in emergency departments (EDs) is not well known. This study aimed to assess the impact of the first-wave pandemic on deaths accounted in the ED of older patients with COVID and non-COVID diseases. <b><i>Methods:</i></b> We used data from the Emergency Department and Elderly Needs (EDEN) cohort (pre-COVID period) and from the EDEN-COVID cohort (COVID period) that included all patients ≥65 years seen in 52 Spanish EDs from April 1 to 7, 2019, and March 30 to April 5, 2020, respectively. We recorded patient characteristics and final destination at ED. We compared older patients in the pre-COVID period, with older patients with non-COVID and with COVID-19. ED-mortality (before discharge or hospitalization) is the prior outcome and is expressed as an adjusted odds ratio (aOR) with 95% interval confidence. <b><i>Results:</i></b> We included 23,338 older patients from the pre-COVID period (aged 78.3 [8.1] years), 6,715 patients with non-COVID conditions (aged 78.9 [8.2] years) and 3,055 with COVID (aged 78.3 [8.3] years) from the COVID period. Compared to the older patients, pre-COVID period, patients with non-COVID and with COVID-19 were more often male, referred by a doctor and by ambulance, with more comorbidity and disability, dementia, nursing home, and more risk according to qSOFA, respectively (<i>p</i> &lt; 0.001). Compared to the pre-COVID period, patients with non-COVID and with COVID-19 were more often to be hospitalized from ED (24.8% vs. 44.3% vs. 79.1%) and were more often to die in ED (0.6% vs. 1.2% vs. 2.2%), respectively (<i>p</i> &lt; 0.001). Compared to the pre-COVID period, aOR for age, sex, comorbidity and disability, ED mortality in elderly patients cared in ED during the COVID period was 2.31 (95% confidence interval [CI]: 1.76–3.06), and 3.75 (95% CI: 2.77–5.07) for patients with COVID. By adding the variable qSOFA to the model, such OR were 1.59 (95% CI: 1.11–2.30) and 2.16 (95% CI: 1.47–3.17), respectively. <b><i>Conclusions:</i></b> During the early first pandemic wave of COVID-19, more complex and life-threatening older with COVID and non-COVID diseases were seen compared to the pre-COVID period. In addition, the need for hospitalization and the ED mortality doubled in non-COVID and tripled in COVID diagnosis. This increase in ED mortality is not only explained by the complexity or severity of the elderly patients but also because of the system’s overload.