Validation of Factors Associated with Difficult Emergency Transport in Tokyo Before and After COVID-19 Pandemic: A...

To clarify and compare factors of difficult emergency transport before and after COVID-19 in Tokyo.

We conducted a retrospective observation study. Data was collected by reviewing electronic medical records, and all patients transferred to our hospital as Tokyo Rule (TR) cases between April 1, 2010, and March 31, 2022, were enrolled. After enrollment, baseline, demographic, clinical characteristics of patients, and prehospital information about emergency medical services (EMS) activity time were collected. The primary outcome was defined as 30-day death. Firstly, we defined pre-COVID-19 group as being before January 15, 2020, and COVID-19 group afterwards. To predict factor for death, a univariate and multivariable logistic-regression analysis were applied to each parameter to identify predictors of death.

Total of 3,988 individuals were included. Of them, 2,005 were in pre-COVID-19 group, and 1,983 in COVID-19 group. In the univariate analysis, age, weekends and holidays, transportation time, respiratory rate, comorbidity of hypertension, and major diagnostic category were associated with death in pre-COVID-19 group. A similar situation was found for age, weekends and holidays, pulse oximetry, respiratory symptoms, and comorbidity of respiratory disease in COVID-19 group. In logistic regression analysis, independent predictors included weekends and holidays, comorbidity of hypertension, and major diagnostic category of gynecology in pre-COVID-19 group and weekends and holidays, respiratory symptoms, and comorbidity of respiratory disease in COVID-19 group.

Factors of TR cases have changed since the COVID-19 pandemic.