Changes in Pediatric Emergency Department Visits During the COVID-19 Pandemic

Haddadin, Zaid; Blozinski, Anna; Fernandez, Kailee N; Vittetoe, Kelly L.; Greeno, Amber; Halasa, Natasha; Lovvorn, Harold N.

doi:10.1542/hpeds.2020-005074

Cited by 44 publications

(46 citation statements)

References 8 publications

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“…Data from one US medical centre reported a significant drop in pediatric ED visits for acute respiratory illnesses over 3 months (March–May 2020) compared to previous years. [ 17 ] This pattern is supported here with national data across a whole year from Israel, and excluding patients ultimately found to be COVID-19 positive, allowing a comprehensive analysis of changing ED use in relation to the timing of the pandemic peaks of increased infection incidence.…”

Section: Discussionsupporting

confidence: 59%

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The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel

Haklai

Applbaum

Myers

et al. 2022

The American Journal of Emergency Medicine

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Background The COVID 19 pandemic has had a crucial effect on the patterns of disease and treatment in the healthcare system. This study examines the effect of the COVID-19 pandemic on respiratory ED visits and admissions broken down by age group and respiratory diagnostic category. Methods Data on non-COVID related ED visits and hospitalizations from the ED were obtained in a retrospective analysis for 29 acute care hospitals, covering 98% of ED beds in Israel, and analyzed by 5 age groups: under one-year-old, 1–17, 18–44, 45–74 and 75 and over. Diagnoses were classified into three categories: Upper respiratory tract infections (URTI), pneumonia, and COPD or asthma. Data were collected for the whole of 2020, and compared for each month to the average number of cases in the three pre-COVID years (2017–2019). Results In 2020 compared to 2017–2019, there was a decrease of 34% in non-COVID ED visits due to URTI, 40% for pneumonia and a 35% decrease for COPD and asthma. Reductions occurred in most age groups, but were most marked among infants under a year, during and following lockdowns, with an 80% reduction. Patients over 75 years old displayed a marked drop in URTI visits. Pediatric asthma visits fell during lockdowns, but spiked when restrictions were lifted, accompanied by a higher proportion admitted. The percent of admissions from the ED visits remained mostly stable for pneumonia; the percent of young adults admitted with URTI decreased significantly from March to October. Conclusions Changing patterns of ED use were probably due to a combination of a reduced rate of viral diseases, availability of additional virtual services, and avoidance of exposure to the ED environment. Improved hygiene measures during peaks of respiratory infections could be implemented in future to reduce respiratory morbidity; and continued provision of remote health services may reduce overuse of ED services for mild cases.

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Section: Discussionsupporting

confidence: 59%

“…Studies of asthma in the United States during the COVID-19 pandemic have shown reduced hospitalizations, fewer ED visits, and improved asthma control during the pandemic, and have linked these favourable outcomes to lockdowns and school closures [ [17] , [18] , [19] , [20] , [21] ].…”

Section: Discussionmentioning

confidence: 99%

The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel

Haklai

Applbaum

Myers

et al. 2022

The American Journal of Emergency Medicine

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“…The overall drop in ED visits during the pandemic seen in this study has been documented by other investigators. 9 , 10 Yet when examining specific complaints, an increase in the percentage of community masking was reflected in a drop in ED visits for non-COVID viral illness and exacerbations of asthma exacerbations and COPD in this retrospective multi-site study. These findings suggest the well-known decrease in person-to-person transmission of respiratory viruses due to masking 4 also has a measurable and positive impact on health systems.…”

Section: Discussionmentioning

confidence: 78%

Masking for COVID-19 Is Associated with Decreased Emergency Department Utilization for Non-COVID Viral Illnesses and Respiratory Conditions in Maryland

Dezman

Stryckman

Zachrison

et al. 2021

The American Journal of Medicine

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Background : Masking, which is known to decrease the transmission of respiratory viruses, was not widely practiced in the United States until the COVID-19 pandemic. This provides a natural experiment to determine whether the percentage of community masking was associated with decreases in emergency department (ED) visits due to non-COVID viral illnesses (NCVI) and related respiratory conditions. Methods: Observational study of ED encounters in a 11-hospital system in BLINDED during 2019-2020. Year-on-year ratios for all complaints were calculated to account for ‘lockdowns’ and the global drop in ED visits due to the pandemic. Encounters for specific complaints were identified using the International Classification of Diseases, version 10. Encounters with a positive COVID test were excluded. Linear regression was used to determine the association of publicly available masking data with ED visits for NCVI and exacerbations of asthma and chronic obstructive pulmonary disease (COPD), after adjusting for patient age, sex, and medical history. Results: There were 285,967 and 252,598 ED visits across the hospital system in 2019 and 2020, respectively. There was a trend towards an association between the year-on-year ratio for all ED visits and the BLINDED stay-at-home order (parameter estimate=-0.0804, p=0.10). A 10% percent increase in the prevalence of community masking was associated with a 17.0%, 8.8%, and 9.4% decrease in ED visits for non-COVID viral illness and exacerbations of asthma exacerbations and COPD, respectively (p<0.001 for all). Conclusions: These findings may be valuable for future public health responses, particularly in future pandemics with respiratory transmission or in severe influenza seasons.

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“…These restrictions, in conjunction with local “stay at home” orders, resulted in a significant decline in hospital-based healthcare services across the globe, including imaging and emergency services [ 4 – 6 ]. ED patient visit volumes decreased 40–75% [ 7 – 9 ], and ED imaging volumes decreased by 28–58% [ 10 – 14 ]. While some proportion of the decreased healthcare utilization is thought to be deferral of elective care [ 15 ], a number of studies have also found visits for emergent conditions, such as ST-elevation myocardial infarction and stroke also decreased in the early pandemic [ 16 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID pandemic on emergency department CT utilization: where do we go from here?

et al. 2022

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Purpose To analyze the impact of the coronavirus disease (COVID) pandemic on emergency department (ED) computed tomography (CT) utilization. Methods A retrospective observational study was conducted assessing seven hospitals’ ED imaging volumes between Jan. 6, 2019, and Feb. 27, 2021. Weekly CT utilization is reported as CTs ordered per 100 ED visits. Utilization was ascertained in aggregate and by body area. Interrupted time series analysis was performed to assess significance of utilization change. Prespecified sensitivity analysis was performed for influenza-like or COVID-like illness (ILI/CLI). Results Weekly ED CT utilization increased from 35.9 CTs per 100 visits (95% confidence interval [95% CI] 35.8–36.1) to 41.8 per 100 visits (95% CI 41.7–42.0) in pre- and post-pandemic periods. Weekly ED CT chest utilization increased immediately following the pandemic declaration (+ 0.52 chest CTs per 100 ED visits, 95% CI 0.01–1.03, p < 0.05) and compared to pre-pandemic period (+ 0.02 per 100 ED visits, 95% CI 0.02–0.05, p < 0.02). For both CT abdomen/pelvis and CT head, there was neither an immediate effect (+ 0.34 CT-AP per 100 ED visits, 95% CI − 0.74 to 1.44, p = 0.89; − 0.42 CT-H per 100 ED visits, 95% CI − 1.53 to 0.70, p = 0.46) nor a change in weekly CT utilization (+ 0.03 CT-AP per 100 ED visits, 95% CI − 0.01 to 0.05, p = 0.09; + 0.03 CT-H per 100 ED visits, 95% CI − 0.01 to 0.06, p = 0.10). Conclusion These data may help formulate future strategies for resource utilization and imaging operations as we envision a future with COVID and other federal mandates affecting imaging utilization and appropriateness. Supplementary Information The online version contains supplementary material available at 10.1007/s10140-022-02071-z.

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Changes in Pediatric Emergency Department Visits During the COVID-19 Pandemic

Cited by 44 publications

References 8 publications

The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel

The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel

Masking for COVID-19 Is Associated with Decreased Emergency Department Utilization for Non-COVID Viral Illnesses and Respiratory Conditions in Maryland

Impact of the COVID pandemic on emergency department CT utilization: where do we go from here?

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