Impact of COVID19 and public health restrictions on emergency department presentations of dermatological conditions.

Abstract

Mandatory stage 3 restrictions in Victoria in response to the SARS-CoV-2 (COVID19) pandemic were implemented on 30 March 2020, permitting individuals to leave home for food and supplies, medical care, exercise, and essential work or education only. Compared to pre-pandemic levels, reduced or delayed presentations to emergency departments were anticipated. This study attempted to quantify the impact of COVID-19 on dermatologic emergency department presentations. Method(s): A retrospective audit was performed at Monash Health, the largest multi-site health service with three emergency departments in Victoria, Australia. Patients with a triage presenting problem of rash, allergic reaction or dermatological problem from 1 April to 30 June 2020 (stage 3 lockdown) were compared to those over the same period in 2019 (no restrictions). Result(s): The total number of dermatology-related ED presentations decreased from 1148 in 2019 to 659 in 2020 (42.60% reduction). Presentations of Australasian Triage Scale (ATS) category 1-3 recorded a lesser decrease (32.75%) as compared with category 4-5 (52.44%). The mean age increased from 18.31 to 23.11 (p = 0.0003). A greater decrease in dermatological complaints was observed in paediatric patients (701-341, 51.4% decrease) compared to adult patients (447-318, 28.9% decrease, p = 0.0001) The mean ATS category decreased from 3.47 to 3.35 (adjusted p = 0.0024) suggesting a higher proportion of increased acuity cases during the pandemic than the previous year. While the decrease in ATS category was statistically significant amongst paediatric patients decreasing from 3.5 to 3.33 (adjusted p = 0.0006), amongst adult patients the reduction in ATS category was not (3.4- 3.36, adjusted p > 0.9999). No significant difference in length of stay in the emergency department was identified between 2019 and 2020. Conclusion(s): Our study observed a reduction in attendance in all groups over the COVID19 stage 3 restriction period, however most pronounced in the ATS category 4-5 group.