Examining the effect of

COVID-19 impact on hospital visits

Tracking the drop in eye-related visits to the emergency department during the pandemic. Colin Kerr reports

The COVID-19 pandemic has had a significant impact on the number of eye-related ED visits and there is a need better health education, according to Ceren Durmaz Engin MD, Dokuz Eylul University, Izmir, Turkey.

In a presentation at the 25th ESCRS Winter Meeting Virtual 2021, Dr Durmaz Engin said the highest decrease was seen in the frequency of acute conjunctivitis cases, which may be secondary to hand hygiene and social distancing measures.

Dr Durmaz Engin and her research team compared the characteristics of eye-related emergency department (ED) visits with ophthalmology consultation during the COVID-19 pandemic in 2020 against an equivalent period in 2019.

Records of 838 patients who admitted to ED for ophthalmic complaints between 11 March 2020 (date of first COVIDpositive case in the country) to 11 September 2020 (Period 1) and 1,585 patients who admitted to ED at equivalent period in the previous year (Period 2) were examined.

The urgency status of complaint, diagnosis, treatment applied, hospitaliation status of patients and total cost of health expenses by institution were compared. Urgency status of the complaint were classified as likely emergent, not likely emergent and undetermined. Records of first three months (11 March – 3 June) and second three months (3 June – 11 September) in 2020 were also compared to reveal the effect of lockdown.

The study found that there was a 47.1% reduction in ED admissions between Period 1 and Period 2. The lockdown also caused a 29% reduction in ED visits for ocular complaints. The top diagnostic categories were corneal abrasion (CA) (percentage of total caseload: 21.3%), corneal foreign body (CFB) (16.6%) and acute conjunctivitis (12.7%) during P2 and CFB (29.5%), CA (13%) and orbital floor fracture (7.4%) during P1 for all study population. While 64.5% of the total cases were likely emergent in P2, the frequency increased to 79.4% during P1 (p<0.001). The type of treatment (p=0.089) and hospitalisation status (p=0.29) were not different between two study periods. There was a 44.3% reduction in health expenses.

Researchers further analysed paediatric and adult populations separately and found 70% and 83% of the complaints were likely emergent during partial lockdown period in paediatric and adult populations, respectively. For the paediatric population, there was a 66% reduction in eye-related ED consultations. Acute conjunctivitis cases were significantly reduced during COVID period, which may be explained by social distancing due to schools being closed and increased emphasis on hand hygiene.

For the adult population, there was a 46% reduction in eyerelated ED consultations. CFB, CA and orbital blow-out fractures were the three most common diagnosis during COVID period. Likely emergent conditions were significantly higher in 2020 compared to 2019 for adults. Flashes and floaters, which need to be evaluated immediately and diagnosed with either posterior vitreous detachment or retinal tear and/or detachment were among the 10 most common diagnoses during the COVID period. The frequency of invasive procedures needed increased to 27% of all cases during the COVID period. As expected, the most common indication for invasive procedures was corneal foreign body in both periods.

“Delayed health-seeking behaviour for subtle or less debilitating symptoms due to fear of contracting the virus by hospital attendance may cause the decrease of ED visits for not likely emergent conditions. Not occupying the ED for non-emergency situations is important both economically and in terms of reducing the workload of healthcare personnel fighting with COVID.

“Taking lessons from the COVID period, more rational use of emergency services can be achieved by health education,” she said.