Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Dec 20, 2023; 13(5): 446-455
Published online Dec 20, 2023. doi: 10.5662/wjm.v13.i5.446
Impact of COVID-19 lockdown on hospital admissions for epistaxis in Germany
Adrian Hoenle, Martin Wagner, Stephan Lorenz, Helmut Steinhart
Adrian Hoenle, Martin Wagner, Helmut Steinhart, Department of Ear, Nose and Throat, Head and Neck Surgery, Marienhospital Stuttgart, Stuttgart 70199, Germany
Stephan Lorenz, Department of Emergency Medicine, Katharinenhospital Stuttgart, Stuttgart 70174, Germany
Author contributions: Hoenle A designed the study, collected and analyzed the data, and wrote and edited the manuscript; Wagner M and Lorenz S collected data for the manuscript; Steinhart H assisted in study design and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethikkommission Marienhospital Stuttgart Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous secondary clinical data which is publicly available.
Conflict-of-interest statement: All the authors report no conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Adrian Hoenle, BSc, MD, Doctor, Surgeon, Department of Ear, Nose and Throat, Head and Neck Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany, Stuttgart 70199, Germany.
Received: June 26, 2023
Peer-review started: June 26, 2023
First decision: August 24, 2023
Revised: August 30, 2023
Accepted: September 28, 2023
Article in press: September 28, 2023
Published online: December 20, 2023

Reports of a decrease in hospital admissions during the coronavirus disease 2019 (COVID-19) lockdown period have raised concerns about delayed or missed diagnoses and treatments for non-COVID-19-related illnesses.


To investigate the impact of the COVID-19 pandemic-induced lockdown and its end on hospital admissions of patients with epistaxis in Germany.


A retrospective analysis based on the national database of the Hospital Remuneration System was used to compare hospital admissions during defined time periods between 2019 and 2022 with the lockdown period as the reference period. This was done on a weekly basis before, during, and after the lockdown. An Interrupted Time Series was used as the analysis method.


In our analysis, we included 26183 patients. The implementation of the lockdown led to a substantial reduction in the overall occurrence of epistaxis among patients (P < 0.05). This effect was most pronounced in the age group of 0-39 years, where the decrease was highly significant (P < 0.001). However, there was no change observed in patients aged 80 years and older (not significant). With the end of the lockdown period, the overall number of patients, especially in the youngest age group, increased abruptly and significantly (P < 0.01).


During the lockdown period, there was a decrease in hospital admissions for younger patients with epistaxis, possibly due to the fear of COVID-19 exposure. We also conclude that the severity of epistaxis was not underestimated in the elderly during the pandemic.

Keywords: COVID-19, Epistaxis, Lockdown, Pandemic, Emergency medicine, Otolaryngology

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems worldwide. In an effort to reduce the spread of the virus, many countries have implemented lockdown measures that restrict movement and social interaction. While these measures have been effective in reducing the transmission of COVID-19, they have also had unintended consequences on healthcare delivery and hospital admissions. Several studies have reported a decrease in hospital admissions during the COVID-19 lockdown period. We showed that the pandemic-induced lockdown resulted in a direct decrease in hospitalizations especially for young patients with epistaxis and an immediate increase in hospitalizations with its end. This might be caused by fear of exposure to COVID-19, unintended consequences of public health recommendations to minimize non-urgent healthcare, or stay at home orders. These findings match with results from previous studies. Conversely, these measures did not lead to any change in older patients, which suggests that at least in this age group, the symptoms of epistaxis should not be underestimated, even with regard to a possible exposure to the coronavirus.