Changing patterns of emergency paediatric presentations during the first wave of COVID-19: learning for the second wave from a UK tertiary emergency department

Abstract

BackgroundThe SARS-CoV-2 pandemic and initial public health response led to significant changes in health service delivery, access and utilisation. However, SARS-CoV-2 illness burden in children and young people (CYP) is low. To inform effective child public health interventions, we aimed to compare patterns of paediatric emergency department presentation during the initial pandemic response with a previous non-pandemic period.MethodsRetrospective review of attendances (0–18 years) over the initial pandemic (2 March 2020–3 May 2020) compared with 2019. Outcome measures included number of attendances, referral source, presenting complaint, discharge diagnosis and disposal. Descriptive statistics with subgroup analysis by age/sex/ethnicity and pandemic time periods (pre-lockdown, lockdown weeks 1–3 and lockdown weeks 4–6) was performed.Results4417 attendances (57% illness and 43% injuries) occurred, compared with 8813 (57% illness and 43% injuries), a reduction of 50%, maximal in lockdown week 2 (−73%). Ranking of top three illness presentations changed across the pandemic weeks. Breathing difficulty dropped from first (300, 25%) to second (117, 21%) to third (59, 11%) (p<0.001). Abdominal pain rose from the third pre-lockdown (87, 7%) and lockdown weeks 1–3 (37, 7%) to second in weeks 4–6 (62, 12%; p=0.004). Fever ranked second (235, 19%) in pre-lockdown and first in weeks 1–3 (134, 24%) and weeks 4–6 (94, 18%; p=0.035).ConclusionsDespite a 50% reduction, there was no significant change in acuity of illness. Rank of illness presentations changed, with abdominal pain ranking second and fever first, an important change from previous, which should prompt further research into causes. CYP-specific public health messaging and guidance for primary care are required in this second wave to ensure access to appropriate emergency services.

COVID-19 Restrictions Are Associated With a Significant Decrease of All Common Respiratory Viral Illnesses in Children

“…[1][2][3][4][5][6][7][8] Studies of pediatric emergency department visits in the United Kingdom and Singapore showed that during lockdown, respiratory illnesses and breathing problems decreased significantly. [9][10][11] No studies have yet looked at the impact of COVID-19 restrictions on the incidence of all common respiratory infections in children. In the counties surrounding our hospital in California in the United States, restrictions were enacted beginning the second week of March of 2020.…”

Lower extremity problems and related surgical procedures before and during the COVID-19 pandemic in a tertiary healthcare institution

“…A study conducted in a university hospital emergency in Turkey determined there was a decrease in the rate of total admissions to the emergency department (from 49.9% to 33.2%) in April compared to March when the first case was announced (17). The results of the studies evaluating the decrease in the number of hospital admissions compared to the previous year in the first periods of the COVID-19 pandemic were as follows, 42% decrease in the USA between March 29 and April 25, 2020 (18), 50% decrease in the UK between March 2 and May 3 (19), 47% decrease in France between March 23-April 5 (20). Similarly, in studies conducted in many countries in the later stages of the pandemic, it was reported that there was a significant decrease in hospital admissions (21,22,23).…”

Covid-19 and Thyroid: A Scopus-based Bibliometric Assessment of Research Output

“…22 Nevertheless, in view of the subsequent Covid-19 waves likely to affect more children, there is a need to be prepared with research strategies aimed at mitigating the effects of co-morbidities such as thyroid disease in addition to general pandemic countermeasures such as public health messaging and guidance for primary care. 23 In this regard, high-volume pediatric centers and researchers already engaged in thyroid research will have to play an active role, specifically in low-income countries. [24][25][26][27][28] We used a single database for the current analysis, similar to most previous scientometric studies.…”