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1417. Impact of COVID-19 Pandemic Lockdown on the Emergency Radiology Workload and Outcome: A Multicentric Italian Study
Authors * Denotes Presenting Author
  1. Vincenzo Vingiani *; U.O.C. Radiologia, P.O. Sorrento
  2. Alessandro Posa; U.O.C. Diagnostica per Immagini e Radiologia Interventistica, Ospedale San Giovanni Calibita Fatebenefratelli
  3. Gianfranco Belmonte; U.O.C. Radiologia, Azienda ospedaliera regionale San Carlo
  4. Claudia Rutigliano; U.O.C. Radiologia, Ospedale “L. Bonomo”
  5. Marialavinia Catalano; Servizio di diagnostica per immagini, Casa di Cura Aurelia Hospital
  6. Giovanna Bertè; Servizio di diagnostica per immagini, Casa di Cura Aurelia Hospital
  7. Andres Abadia; University of Florida
Objective:
Due to COVID-19 spread, the Italian government decided to go into lockdown from March 9th to May 3rd, 2020, which led to changes in the workflow of radiological examinations in emergency radiology. Therefore, the aim of this multicentric study is to illustrate how these changes affected the workload and outcomes of radiological exams during the pandemic.

Materials and Methods:
The exams performed in the radiology departments of four Italian hospitals from March 23th to April 12th, 2020 were retrospectively reviewed and compared to the exams conducted during the same time-period in 2019. Only exams coming from the emergency department (ED) were included. Two radiologists from each hospital defined the cases as positive or negative findings, based on independent blind readings of the imaging studies and correlation with the clinical indication. In case of differences in the evaluation, consensus was reached amongst them via discussion. Continuous measurements are presented as median and interquartile range (IQR), while categorical measurements are presented as frequency and percentages; p-values were calculated using T-test, Mann-Whitney test and the Chi-squared test.

Results:
There was a significant reduction in the amount of exams performed in 2020: there were 745 patients [395male; 62 years (44-78)] who underwent radiological examinations vs. 2623 [1364 male; 56 years (35-76)] in 2019 (p<.001). Furthermore, the total number of ED exams dropped from 3206 (2019) to 939 (2020), with a relative increase of CT examinations from 23% to 33% (p<.001). The percentage of patients with a positive finding was significantly higher in 2020 (355 of 745, 48%) compared to 2019 (684 of 2622, 26%) (p<.001). The relative percentage of trauma indication as the reason for the radiological exam dropped from 51% to 34% in 2020 (p<.001); while the thoracic indication increased from 17% to 28% (p<.001).

Conclusion:
The reduction of emergency radiological examinations might be a result of the movement restrictions enforced during the lockdown, and possible fear of the hospital as a contagious place. Our findings also showed a relative increase of positive cases. This might be due to the fear of hospitals and the delay in health care access; i.e., we hypothesize that given the fear for potential infection, people seem to be waiting for more severe symptoms to occur before seeking hospital care, leading to only people with more serious conditions heading in, thus resulting in a relative increase of positive findings. We confirmed an overall reduction of examinations performed for traumas and a relative increase of the thoracic examinations. Furthermore, the relative increase of CT examinations might be due to more severe conditions of the patients coming to ED. Finally, the significantly higher median age could be explained by the more serious conditions to which the elderly were exposed during the pandemic. Knowing the workflow changes in radiological examinations during a lockdown might lead to a better preparation of hospitals for readiness to react in similar situations.