Nationwide Age-Specific Changes in EMS-Transported Emergency Department Visits in Korea During the Pre-COVID-19 and Post-COVID-19 Periods

Background/Objectives: The COVID-19 pandemic substantially changed emergency care utilization patterns, but nationwide evidence comparing age-specific changes in 119 EMS-transported emergency department (ED) visits between children and adults remains limited. Using nationwide data from Korea’s public EMS system, we evaluated pre-COVID-19 and post-COVID-19 changes in 119 EMS-transported ED visits using KTAS-defined emergency acuity, ED disposition, and ED length of stay (ED LOS). Methods: We conducted a nationwide retrospective observational study using the National Emergency Department Information System. We included all 119 EMS-transported ED visits from 1 January 2019 to 31 December 2020 and used 23 February 2020 as the index date. Children were aged <20 years and adults were aged ≥20 years. The primary outcome was KTAS-defined emergency acuity; secondary outcomes were ED disposition and ED LOS. Multivariable logistic regression analyses were performed separately by age group. Results: A total of 2,104,163 119 EMS-transported ED visits were included. The proportion of pediatric visits decreased from 9.3% to 6.8% after COVID-19. Among children, crude emergency acuity decreased, whereas hospital admission and ED mortality increased; after adjustment, the odds of emergency acuity and hospital admission were slightly higher in the post-COVID-19 period. Among adults, emergency acuity, hospital admission, ED mortality, and ED LOS all increased, and adjusted odds of emergency acuity and hospital admission were also higher. Conclusions: Children showed mixed changes across severity-related indicators, whereas adults demonstrated a more consistent post-COVID-19 shift toward a higher-acuity clinical profile. Because these indicators were measured after ED arrival, the findings should be interpreted cautiously. Further studies using linked prehospital and hospital data are needed to better evaluate age-specific changes in EMS use.