Inpatient volume fell 17% during depths of COVID-19

By Brian Casey, staff writer

June 19, 2020 -- The COVID-19 pandemic prompted a decline in inpatient imaging volume at a health system in the northeastern U.S. that hit a low of 17% at the worst point of the outbreak, according to a June 18 study in the Journal of the American College of Radiology. But volume rebounded afterward to finish down just 4% compared with 2019.

Healthcare's response to the COVID-19 outbreak prompted a range of social-distancing measures that resulted in a massive decline in medical procedures considered to be nonessential. Within radiology, outpatient imaging was hit particularly hard, with some studies documenting a decline of over 50% in imaging volume, depending on modality.

But what about inpatient imaging? To answer this question, a multicenter research team led by Dr. Jason Naidich, chair of radiology at Northwell Health, analyzed changes in imaging volume at the New York-based health system starting January 1 through April 18, 2020, and compared it with volumes in comparable periods in 2019 (JACR, June 18, 2020).

They divided their analysis into distinct periods to provide a more focused look at imaging volume during different stages of the outbreak. They also broke down the data by modality. The group noted that the first COVID-19 case was confirmed at Northwell on March 8, one week after the first confirmed case in New York City and during week 11 of their study period.

The data indicated that volume at Northwell hit a nadir in week 10-13 of 2020, with imaging exams down 16.6% compared with the same period in 2020. Exam volume began to rebound after that, and it was only down 9.6% as of week 14-16. By the end of the study period, volume was down only 4.2% compared with the year before.

Change in inpatient imaging volume during COVID-19 outbreak
Period 2019 2020 Percent change

(weeks 1-9)

96,609 94,302 -2.4%

(weeks 10-16)

78,902 68,168 -13.6%
Early post-COVID-19

(weeks 10-13)

45,221 37,732 -16.6%
Late post-COVID-19

(weeks 14-16)

33,681 30,436 -9.6%
Week 16 11,003 10,546 -4.2%
Weeks 1-16 175,511 162,470 -7.4%

The authors found that the type of imaging being used also changed during the COVID-19 pandemic. For a variety of reasons, imaging experts have discouraged the use of cross-sectional imaging modalities for COVID-19, recommending instead portable technologies that can be taken to a patient's bedside, such as mobile x-ray.

Change in imaging volume by modality, pre-COVID-19 vs. post‑COVID‑19
Modality Percent volume change
Radiography +12.4%
CT -24.6%
Interventional -26.6%
Ultrasound -31.2%
MRI -43.7%
Nuclear medicine -53%

The researchers concluded their analysis by noting that the findings on changes in imaging exam volume due to a viral pandemic could be useful in preparing for a potential resurgence of COVID-19, especially in terms of resource utilization and staff requirements.

"These results may be helpful in developing new imaging utilization guidelines and departmental policies aimed at optimally accommodating the unique imaging needs for COVID-19 patients," they wrote.

Copyright © 2020

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