Objectives: Our goal was to determine whether the proportion of ED visits for specific psychiatric conditions, namely anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, changed after the arrival of COVID-19.

Background: In March 2020, the COVID-19 pandemic reached the New York tri-state area, which, at the time, was one of the regions in the United States (US) that the virus most severely affected. ED visits dramatically declined, likely due to social isolation mandates and fear of exposure to the virus. Quarantining at home, fear of becoming sick, and job disruptions caused the level of stress in the population to increase. In a previous US study, the proportion of ED visits for some psychiatric conditions increased.

Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching and non-teaching in rural, suburban and urban areas. Total annual ED volumes were 12,000 to 122,000. Population: Consecutive ED patients = 21 years old from March 1 to November 30 in 2019 and 2020. Data analysis: We tallied the number of patients in 2019 and 2020 with anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, identified using International Classification of Disease codes (version 10). We calculated the proportion of these visits to total ED visits in 2019 and 2020. We report the changes in these proportions from 2019 to 2020, along with 95% CIs.

Results: Total ED visits decreased 27%, from 844,017 in 2019 to 618,195 in 2020. In 2019 and 2020 combined, the number of patients were: 13,151 with anxiety disorders, 6884 with depression, 8886 with suicidal ideation/self-harm, 3252 with bipolar disorder, and 7129 with psychotic disorders. The changes [with 95% CIs] in the proportion of visits from 2019 to 2020 were: anxiety disorders -1% [-4,+3%], depression -5% [-10,-1%], self-harm/suicidal thoughts +23% [+18,+29%], bipolar disorder +14% [+6, +22%], and psychotic disorders +23% [+18,+29%].

Conclusion: The proportion of adult ED visits for self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders increased following the arrival of COVID-19, whereas the proportions for anxiety and depression changed minimally. These results are somewhat different from the findings in the previously reported study. Our study highlights the need for continued surveillance of the impact of COVID-19 on mental health.

Objectives: The goal of our study was to determine whether there was a change in the proportion of ED visits for alcohol abuse following the arrival of COVID-19.

Background: In March of 2020, COVID-19 arrived in the New York Metropolitan area. Total ED visits decreased markedly, likely because of fear of exposure to the virus as well as social isolation mandates. Concerns have been raised regarding the possible adverse effects that COVID-19 may have on increased abuse of alcohol. COVID-19 triggered bouts of anxiety, isolation from peers, and increased family tensions because of job disruptions and quarantining within families. A CDC study showed that despite decreased total ED visits, compared to 2019, the proportion of ED mental health related visits in 2020 increased. The goal of our study was to determine whether there was a change in the proportion of ED visits for alcohol abuse following the arrival of COVID-19.

Methods: Design: Retrospective cohort. Setting: EDs of 27 hospitals within 150 miles of New York City. Hospitals were teaching and non-teaching in rural, suburban, and urban areas. Total annual ED volumes ranged from 12,000 to 122,000. Population: Consecutive patients seen by ED physicians. The database contained visits between March 1 and November 30 in 2019 and 2020. Data analysis: We identified patients with alcohol abuse using International Classification of Disease codes, version 10 (ICD-10). We tallied the number of ED visits for ICD-10 codes with at least 100 visits in the database. We calculated the proportion of these visits to total ED visits in 2019 and 2020. We report the relative change in this proportion from 2019 to 2020, along with the 95% CI.

Results: The database contained 1,161,080 visits in 2019 and 814,252 in 2020. Of these, 15,057 and 12,467 patients had a diagnosis of alcohol abuse in 2019 and 2020, respectively. For patients with alcohol abuse diagnoses in 2019 and 2020 the average ages were 46 and 47 years and females comprised 25% and 23%, respectively. The relative change in the proportion of visits for alcohol abuse from 2019 to 2020 had a statistically significant increase of 18% (95% CI: 15%-21%).

Conclusion: The proportion of ED visits for alcohol abuse increased following the arrival of COVID-19 in the New York metropolitan area. Our results are consistent with the CDC study showing the proportion of ED mental health related visits increased.

Introduction: Aortic dissection is a rare event. While the most frequent symptom is chest pain, that is a common emergency department (ED) chief complaint and other diseases causing chest pain occur much more often. Furthermore, 20% of dissections are without chest pain and 6% are painless. For these reasons, diagnosing dissections may be challenging. Our goal was to determine the number of total ED and atraumatic chest pain patients for every aortic dissection diagnosed by emergency physicians.Methods: Design: Retrospective cohort. Setting: 33 suburban and urban New York and New Jersey EDs with annual visits between 8,000 and 80,000. Participants: Consecutive patients seen by emergency physicians from 1-1-1996 through 12-31-2010. Observations: We identified aortic dissection and atraumatic chest pain patients using the International Classification of Diseases 9th Revision and Clinical Modification codes. We then calculated the number of total ED and atraumatic chest pain patients for every aortic dissection, along with 95% confidence intervals (CIs).Results: From a database of 9.5 million ED visits, we identified 782 aortic dissections or one for every 12,200 (95% CI [11,400-13,100]) visits. The mean age of dissection patients was 66±16 years and 38% were female. There were 763,000 (8%) with atraumatic chest pain diagnoses. Thus, there is one dissection for every 980 (95% CI [910-1,050]) atraumatic chest pain patients.Conclusion: The diagnosis of aortic dissections by emergency physicians is rare and challenging. An emergency physician seeing 3,000 to 4,000 patients a year would diagnose an aortic dissection approximately every three to four years.