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Nationwide Age-Specific Changes in EMS-Transported Emergency Department Visits in Korea During the Pre-COVID-19 and
Min-Jung Kim1, Jae-Hyun Kwon1, Soo Hyun Park1
1Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea.
Insights
The COVID-19 pandemic altered emergency care use, with children showing mixed changes in acuity and adults experiencing increased emergency severity. Further research is needed to understand these age-specific shifts in emergency medical services (EMS) use.
Area of Science:
- Emergency Medicine
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted emergency department (ED) utilization patterns.
- Nationwide data comparing age-specific changes in emergency medical services (EMS)-transported ED visits pre- and post-COVID-19 are limited.
- Understanding these shifts is crucial for public health preparedness.
Purpose of the Study:
- To evaluate age-specific changes in 119 EMS-transported ED visits before and after the COVID-19 pandemic.
- To analyze changes in emergency acuity, ED disposition, and ED length of stay (LOS) for children and adults.
- To identify trends in emergency care utilization across different age groups.
Main Methods:
- Nationwide retrospective observational study using the National Emergency Department Information System (2019-2020).
- Inclusion of all 119 EMS-transported ED visits, with February 23, 2020, as the index date.
- Multivariable logistic regression analyses performed separately for pediatric (<20 years) and adult (≥20 years) age groups.
Main Results:
- A total of 2,104,163 visits were analyzed; the proportion of pediatric visits decreased post-COVID-19.
- Children showed mixed changes: decreased crude acuity but increased hospital admission and ED mortality.
- Adults exhibited a consistent increase in emergency acuity, hospital admission, ED mortality, and ED LOS post-COVID-19.
Conclusions:
- Adults demonstrated a clear shift towards a higher-acuity clinical profile post-COVID-19.
- Children's responses were mixed, indicating varied impacts of the pandemic on pediatric emergency care.
- Findings highlight the need for cautious interpretation and further research with linked prehospital and hospital data to fully assess age-specific EMS utilization changes.
Abstract:
Background/Objectives: The COVID-19 pandemic substantially changed emergency care utilization patterns, but nationwide evidence comparing age-specific changes in 119 EMS-transported emergency department (ED) visits between children and adults remains limited. Using nationwide data from Korea's public EMS system, we evaluated pre-COVID-19 and post-COVID-19 changes in 119 EMS-transported ED visits using KTAS-defined emergency acuity, ED disposition, and ED length of stay (ED LOS). Methods: We conducted a nationwide retrospective observational study using the National Emergency Department Information System. We included all 119 EMS-transported ED visits from 1 January 2019 to 31 December 2020 and used 23 February 2020 as the index date. Children were aged <20 years and adults were aged ≥20 years. The primary outcome was KTAS-defined emergency acuity; secondary outcomes were ED disposition and ED LOS. Multivariable logistic regression analyses were performed separately by age group. Results: A total of 2,104,163 119 EMS-transported ED visits were included. The proportion of pediatric visits decreased from 9.3% to 6.8% after COVID-19. Among children, crude emergency acuity decreased, whereas hospital admission and ED mortality increased; after adjustment, the odds of emergency acuity and hospital admission were slightly higher in the post-COVID-19 period. Among adults, emergency acuity, hospital admission, ED mortality, and ED LOS all increased, and adjusted odds of emergency acuity and hospital admission were also higher. Conclusions: Children showed mixed changes across severity-related indicators, whereas adults demonstrated a more consistent post-COVID-19 shift toward a higher-acuity clinical profile. Because these indicators were measured after ED arrival, the findings should be interpreted cautiously. Further studies using linked prehospital and hospital data are needed to better evaluate age-specific changes in EMS use.
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