Background: Occupational accidents pose a pervasive global challenge, impacting a vast number of workers across diverse industries. They serve as a critical gauge of the effectiveness of occupational prevention, health, and safety systems, warranting significant attention in both research and intervention endeavors. In 2020, Italy emerged as the first Western nation to confront a widespread outbreak of COVID-19, a situation that imposed immense pressure on the Italian healthcare system, necessitating critical interventions to curb the spread of the virus. Objectives: This study aims at understanding the impact COVID-19 has had on occupational accidents, a relatively understudied field in the context of COVID-19 literature. The primary objective is to examine how the incidence of workplace accidents was affected by COVID- 19 by analyzing the number of patients who sought emergency care before and during the first two waves of the pandemic at the San Matteo Hospital in Pavia, Lombardia. Our secondary objectives were to analyze the gender distribution among patients who sought medical care at our ED during the pandemic and to assess the number of patients triaged as high intensity as well as the admission rates. Materials and methods: This study is a single-center, retrospective observational analysis of the epidemiological and clinical records of patients who presented to the Emergency Department at the San Matteo Hospital in Pavia, Italy between 1st January and 31st December for each year from 2014 to 2020 for any medical reason. Patients were categorized based on their diagnosis at the time of ED access, whether it was work-related or not. We identified a "pandemic group" of patients who accessed the ED during the first two COVID- 19 waves in Italy from 21st February to 18th May 2020 and from 14th September to 31st December 2020. Patients who presented during the same time periods in the years 2014-2019 were designated as the pre-COVID-19 group, serving as the baseline average. Results: In 2020 we documented an approximate 40% reduction in total and daily ED visits for work-related reasons during the initial outbreak compared to previous years. Additionally, we documented an approximate 26% reduction in both total and daily ED accesses for work-related reasons when comparing the period of the second wave with previous years. Gender analysis revealed a divergent trend only for occupational accidents, probably because of the larger male sample. In terms of accesses to the Emergency Department for work related reasons assigned a high intensity care entry code, a statically significant decrease in the total number was appreciated during the initial outbreak when comparing to the average value of the previous years. The trend, however, was not maintained during the second wave. Admission numbers did not show noteworthy changes during the initial outbreak, with absence of statistical significance for changes in both total work-related accesses and the various causes. Only with the second wave a notable decrease in admissions was observed, specifically concerning total work-related accesses and occupational accidents. Conclusions: An overall trend in reduction of ED accesses for both general and work-related reasons was appreciated in 2020 compared to the previous years, without relevant differences between genders and more marked during the first rather than the second wave of the pandemic, in line with the overall decrease of utilization of healthcare service for non- COVID-19 related causes. The findings can largely be attributed to the implementation of lockdown measures and governmental restrictions, along with the transition to remote work. A corresponding decline was noted also for accesses classified as high intensity while the number of admissions exhibited a contrasting pattern, which we consider attributable to a self-selection phenomenon based on severity and COVID-19 cases categorized as workplace accidents.
Background: Gli infortuni sul lavoro rappresentano una sfida globale diffusa, che colpisce un vasto numero di lavoratori in settori diversi. Nel 2020, l'Italia è stata la prima nazione occidentale ad affrontare un'epidemia diffusa di COVID-19, una situazione che ha posto un'enorme pressione sul sistema sanitario italiano, richiedendo interventi critici per contenere la diffusione del virus. Obiettivi: Questo studio mira a comprendere l'impatto che il COVID-19 ha avuto sugli infortuni sul lavoro. L'obiettivo principale è analizzare come il COVID-19 abbia influenzato l'incidenza degli infortuni sul lavoro, analizzando il numero di pazienti che hanno richiesto cure d'urgenza prima e durante le prime due ondate della pandemia presso l'Ospedale San Matteo a Pavia, in Lombardia. Gli obiettivi secondari includono l'analisi della distribuzione per genere tra i pazienti che hanno richiesto cure mediche presso il nostro Pronto Soccorso durante la pandemia, nonché la valutazione del numero di pazienti classificati come alta intensità e dei tassi di ricovero. Materiali e metodi: Questo studio è un'analisi osservazionale retrospettiva che si basa sui dati epidemiologici e clinici dei pazienti che si sono presentati al Pronto Soccorso dell'Ospedale San Matteo a Pavia, in Italia, nel periodo compreso tra il 1° gennaio e il 31 dicembre di ciascun anno dal 2014 al 2020, per qualsiasi motivo medico. I pazienti sono stati categorizzati in base alla diagnosi al momento dell'accesso al Pronto Soccorso. Abbiamo identificato un "gruppo pandemico" di pazienti che hanno fatto ricorso al Pronto Soccorso durante le prime due ondate di COVID-19 in Italia, dal 21 febbraio all'18 maggio 2020 e dal 14 settembre al 31 dicembre 2020. I pazienti che si sono presentati nello stesso periodo negli anni 2014-2019 sono stati considerati come gruppo pre-COVID-19. Risultati: Nel 2020 abbiamo documentato una riduzione approssimativa del 40% delle visite totali e giornaliere al Pronto Soccorso per motivi legati al lavoro durante l'epidemia iniziale, rispetto agli anni precedenti. Inoltre, abbiamo registrato una riduzione approssimativa del 26% sia nel numero totale che nelle visite giornaliere al Pronto Soccorso per motivi legati al lavoro durante il periodo della seconda ondata. L'analisi per genere ha evidenziato una divergenza solo per gli infortuni sul lavoro, probabilmente a causa del maggior campione di pazienti maschi. Per quanto riguarda gli accessi al Pronto Soccorso per motivi legati al lavoro con codice di priorità elevata, è stata riscontrata una diminuzione statisticamente significativa nel numero totale durante l'epidemia iniziale. Tuttavia, questa tendenza non è stata mantenuta durante la seconda ondata. Il numero di ricoveri non ha mostrato cambiamenti significativi durante l'epidemia iniziale, senza significatività statistica per le variazioni sia negli accessi totali legati al lavoro che nelle diverse cause. Solo con la seconda ondata è stata osservata una notevole diminuzione dei ricoveri, in particolare per quanto riguarda gli accessi totali legati al lavoro e gli infortuni sul lavoro. Conclusioni: Nel complesso, si è osservata una tendenza generale di riduzione degli accessi al Pronto Soccorso sia per motivi generici che legati al lavoro nel 2020 rispetto agli anni precedenti, senza differenze significative tra i generi e con una diminuzione più marcata durante la prima ondata della pandemia rispetto alla seconda. Questi risultati possono essere in gran parte attribuiti all'attuazione delle misure di lockdown e alle restrizioni governative, oltre che al passaggio al lavoro in remoto. È stato osservato anche un calo corrispondente negli accessi classificati come alta intensità, mentre il numero di ricoveri ha mostrato un pattern contrastante, che riteniamo possa essere attribuito a un fenomeno di autoselezione basato sulla gravità e ai casi di COVID-19 categorizzati come infortuni sul lavoro.
EFFECTS OF THE COVID-19 PANDEMIC ON EMERGENCY DEPARTMENT ACCESSES DUE TO OCCUPATIONAL ACCIDENTS
CANAMERI, REI
2022/2023
Abstract
Background: Occupational accidents pose a pervasive global challenge, impacting a vast number of workers across diverse industries. They serve as a critical gauge of the effectiveness of occupational prevention, health, and safety systems, warranting significant attention in both research and intervention endeavors. In 2020, Italy emerged as the first Western nation to confront a widespread outbreak of COVID-19, a situation that imposed immense pressure on the Italian healthcare system, necessitating critical interventions to curb the spread of the virus. Objectives: This study aims at understanding the impact COVID-19 has had on occupational accidents, a relatively understudied field in the context of COVID-19 literature. The primary objective is to examine how the incidence of workplace accidents was affected by COVID- 19 by analyzing the number of patients who sought emergency care before and during the first two waves of the pandemic at the San Matteo Hospital in Pavia, Lombardia. Our secondary objectives were to analyze the gender distribution among patients who sought medical care at our ED during the pandemic and to assess the number of patients triaged as high intensity as well as the admission rates. Materials and methods: This study is a single-center, retrospective observational analysis of the epidemiological and clinical records of patients who presented to the Emergency Department at the San Matteo Hospital in Pavia, Italy between 1st January and 31st December for each year from 2014 to 2020 for any medical reason. Patients were categorized based on their diagnosis at the time of ED access, whether it was work-related or not. We identified a "pandemic group" of patients who accessed the ED during the first two COVID- 19 waves in Italy from 21st February to 18th May 2020 and from 14th September to 31st December 2020. Patients who presented during the same time periods in the years 2014-2019 were designated as the pre-COVID-19 group, serving as the baseline average. Results: In 2020 we documented an approximate 40% reduction in total and daily ED visits for work-related reasons during the initial outbreak compared to previous years. Additionally, we documented an approximate 26% reduction in both total and daily ED accesses for work-related reasons when comparing the period of the second wave with previous years. Gender analysis revealed a divergent trend only for occupational accidents, probably because of the larger male sample. In terms of accesses to the Emergency Department for work related reasons assigned a high intensity care entry code, a statically significant decrease in the total number was appreciated during the initial outbreak when comparing to the average value of the previous years. The trend, however, was not maintained during the second wave. Admission numbers did not show noteworthy changes during the initial outbreak, with absence of statistical significance for changes in both total work-related accesses and the various causes. Only with the second wave a notable decrease in admissions was observed, specifically concerning total work-related accesses and occupational accidents. Conclusions: An overall trend in reduction of ED accesses for both general and work-related reasons was appreciated in 2020 compared to the previous years, without relevant differences between genders and more marked during the first rather than the second wave of the pandemic, in line with the overall decrease of utilization of healthcare service for non- COVID-19 related causes. The findings can largely be attributed to the implementation of lockdown measures and governmental restrictions, along with the transition to remote work. A corresponding decline was noted also for accesses classified as high intensity while the number of admissions exhibited a contrasting pattern, which we consider attributable to a self-selection phenomenon based on severity and COVID-19 cases categorized as workplace accidents.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/16058