Trends in Emergency Department Visits during COVID-19

A recent study examined changes in U.S. emergency department (ED) visits for disaster-related mental health conditions, suicide attempts, overdoses, and violence outcomes during the COVID-19 pandemic. Using data from the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program, the study looked at nearly 190 million ED visits between December 30, 2018 and October 10, 2020.

This study analyzed both the number of ED visits and the rates (the number of ED visits per 100,000 ED visits) associated with each outcome. The analysis found that total ED visits decreased starting March 16, 2020 after COVID-19 mitigation measures were implemented. Comparing the median number of ED visits between March 15 and October 10, 2019 to the same period in 2020, they found the number of visits was higher in 2020 for suicide attempts and all overdose-related visits, including opioid overdoses. In comparison, visit counts for intimate partner violence and suspected child abuse and neglect were significantly lower in 2020. Median rates of all outcomes studied were also higher in 2020 than in 2019, except for intimate partner violence.

The increased isolation associated with quarantines and school closures, in addition to reduced reporting and help seeking, might account for the decrease in ED visits for intimate partner violence and child abuse. The authors note several limitations of this study, namely that the sample may not be representative of the U.S. population, as not all hospitals contribute data to the surveillance program. Since the data were not stratified based on race/ethnicity or geography, potential disparities could not be determined. In addition, ED visits fluctuate throughout the year and the total number of visits were different for 2019 and 2020. The difference in rates could be influenced by characteristics of the populations served or changes in the total ED visits. However, the additional analyses of median rates allowed for a more valid comparison of the volume of ED visits for the two time periods.

Holland, K. M., Jones, C., Vivolo-Kantor, A. M., Idaikadar, N., Zwald, M., Hoots, B., Yard, E., D’Inverno, A., Swedo, E., Chen, M. S., Petrosky, E., Board, A., Martinez, P., Stone, D. M., Law, R., Coletta, M. A., Adjemian, J., Thomas, C., Puddy, R. W., . . . Houry, D.  (2021). Trends in U.S. Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic. JAMA Psychiatry, 78(4), 372–379.