COVID-19 Pandemic Results in Decreased Non-Urgent Urologic-Related Presentations to the Emergency Department
Frances H. Kazal, BA1, Alejandra Balen, MD2, Janine Molino, PhD2, Christopher Tucci, RN2, Gyan Pareek, MD2, David Sobel, MD2.
1The Warren Alpert Medical School at Brown University, Providence, RI, USA, 2Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA.
Background: Recent international medical research has focused specifically on changes to urologic presentations to the ED during the COVID-19 pandemic. Urologic-related visits to the ED are variable in their acuity, ranging from non-emergent to life-threatening. Our research focuses on differences in frequency between urgent and non-urgent visits during the first months of the pandemic to further elucidate delayed access to urologic care in the ED. We hypothesized that there would be a significant difference in urological cases evaluated in the ED during the first four months of 2019 compared to that of 2020. Furthermore, we investigated compelling trends amongst specific disease presentations during this time.
Methods: Data was collected from emergency department records from two academic institutions in the United States. All adult urologic-related cases that presented to the ED, during the time periods of January-April 2019 and January-April 2020. Presentations were included if the chief complaint or diagnosis included urologic conditions. Retrospective data was collected on these individuals and through these two separate time intervals, 1,838 urological presentations were organized by diagnosis category. They were then divided into urgent and non-urgent categories based on clinical diagnosis. A retrospective analysis was performed comparing the frequency and type of urologic-related presentations. Interrupted time series regression models were used to determine how urologic-related ED visits changed due to the COVID-19 pandemic. All statistical analysis was performed using SAS version 9.4 (SAS Institute Inc., Cary, NC).
Results: A total of 1,838 urologic-related ED visits were included in the analysis. (Table 1). There was a statistically significant decrease in total urologic-related ED visits after the COVID-19 pandemic began by 76 visits per month with a 36.9% reduction (p=0.002). While there was no difference in the number of urgent ED visits due to the COVID-19 pandemic (p=0.13), there was a statistically significant decrease in non-urgent ED visits by 68 visits per month with a 37% reduction (p=0.002). When examining the individual visit types, there were no differences in visit volume except for hematuria and nephrolithiasis/ureterolithiasis visits. There was a statistically significant decrease in hematuria-related ED visits, by 11 visits per month (p=0.03). Similarly, there was a statistically significant decrease in nephrolithiasis/ureterolithiasis-related ED visits, by 28 visits per month (p=0.04).Conclusion:The COVID-19 pandemic coincided with a significant decrease in the number of non-urgent urologic presentations to our institution’s ED. Specifically, there was a significant decrease in the number of patients presenting with hematuria and nephrolithiasis-related issues. There was no significant decrease in the number of urgent urologic consults. Follow up study is indicated to investigate the downstream effects of delayed evaluation for these non-urgent urologic diagnoses. 
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