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A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19

Natasha F Daniels, Raiiq Ridwan, Ed BG Barnard, Talha M Amanullah and Catherine Hayhurst
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DOI: https://doi.org/10.7861/clinmed.2020-1093
Clin Med July 2021
Natasha F Daniels
AUniversity of Cambridge School of Clinical Medicine, Cambridge, UK
Roles: final year medical student
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  • For correspondence: tasha.dan@outlook.com
Raiiq Ridwan
BCambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Roles: specialty trainee in emergency medicine
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Ed BG Barnard
CRoyal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham, UK and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Roles: consultant in emergency medicine
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Talha M Amanullah
DCambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Roles: junior clinical fellow in emergency medicine
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Catherine Hayhurst
ECambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Roles: consultant in emergency medicine
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    Fig 1.

    Bar charts showing the total number of ED attendances, number of FA patients and number of FA visits between March to June in 2019 (control) and in 2020 (the COVID-19 period). ED = emergency department, FA = frequent attender, FA-MUS = frequent attender with medically unexplained symptoms, FA non-MUS = frequent attender with a presentation that was not MUS.

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    Table 1.

    A comparison of emergency department overall attendances, frequent attenders, and frequent attenders with medically unexplained symptoms between two 122-day periods in 2019 (Control) and 2020 (COVID-19)

    ControlCOVID-19RR (95%CI), p-value
    ED visits, n42,78528,806
    ED visits per 1kpop/yr114.477.0
    Frequent attenders
    Patients, n163147
    Patients per 1kpop/yr1.31.20.95 (95%CI 0.90–1.01), p=0.13
    ED visits, n11851000
    ED visits per 1kpop/yr9.58.00.92 (95%CI 0.90–0.94), p<0.0001
    Frequent attenders with medically unexplained symptoms
    Patients, n4465
    Patients per 1kpop/yr0.40.51.5 (95%CI 1.1–1.8), p=0.0006
    ED visits, n149267
    ED visits per 1kpop/yr1.22.11.8 (95%CI 1.6–2.0), p<0.0001
    • ED = emergency department; RR = relative risk; 95%CI = 95% confidence interval; 1kpop/year = 1,000 population at risk per year incidence

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    Table 2.

    The frequency of medically unexplained symptom presenting complaint categories in frequent emergency department attenders between two 122-day time periods in 2019 (control) and 2020 (COVID-19)

    MUS diagnosisControlCOVID-19p-value
    Non-cardiac chest pain, n (%)72 (48.3%)117 (43.8%)0.41
    Abdominal pain, n (%)35 (23.5%)56 (21.0%)0.62
    Neurological, n (%)13 (8.7%)33 (12.4%)0.33
    Non-epileptiform seizure, n (%)12 (8.1%)16 (6.0%)0.42
    Musculoskeletal, n (%)3 (2.0%)15 (5.6%)0.13
    Shortness of breath, n (%)011 (4.1%)<0.01
    Other, n1419
    Total, n149267
    • MUS = medically unexplained symptoms

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A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19
Natasha F Daniels, Raiiq Ridwan, Ed BG Barnard, Talha M Amanullah, Catherine Hayhurst
Clinical Medicine Jul 2021, 21 (4) e399-e402; DOI: 10.7861/clinmed.2020-1093

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A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19
Natasha F Daniels, Raiiq Ridwan, Ed BG Barnard, Talha M Amanullah, Catherine Hayhurst
Clinical Medicine Jul 2021, 21 (4) e399-e402; DOI: 10.7861/clinmed.2020-1093
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