Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments

Finkelstein, Yaron; Maguire, Bryan; Zemek, Roger; Osmanlliu, Esli; Kam, April J.; Dixon, Andrew; Desai, Neil; Sawyer, Scott; Emsley, Jason G.; Lynch, Tim; Mater, Ahmed; Schuh, Suzanne; Rumantir, Maggie; Freedman, Stephen B.

doi:10.1097/pec.0000000000002484

Cited by 59 publications

(75 citation statements)

References 45 publications

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“…1 : General health services include different levels of care or type of service; 2 : aggregated data and/or no specification of the different periods of analysis; 3 : studies that did not analyze whether the changes were statistically significant (the rest of articles presented results statistically significant); AF: associated factors; ED: emergency department; ICU: intensive care unit; IRR: incidence rate ratio; OB-GYN: obstetrics-gynecology; OR: odds ratio; PC: primary care; RR: relative risk; SC: secondary care; SRH: sexual and reproductive health. With regard to the type of service, of the studies on realized access, 5 focused on health services in general [46][47][48][49][50]; 12 on emergencies [51][52][53][54][55][56][57][58][59][60][61][62] (of which 5 were related to pediatric emergencies [56][57][58]60,61]); 15 on secondary care (SC) (outpatient visits, hospital admissions, etc., for nephrology [63], oncology [64,65], pediatrics [66], psychiatry [67,68], rehabilitation [69], respiratory diseases [70], sexual and reproductive health (SRH) [71,[73][74][75], and traumatology [78,79]); two on primary care (PC) [80,81]; one on preventive services…”

Section: Resultsmentioning

confidence: 99%

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Pujolar-Díaz

Oliver-Anglès

Vargas

et al. 2022

IJERPH

159

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The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.) for original articles published between December 2019 and September 2021. A total of 53 articles were selected and analyzed using the Aday and Andersen framework as a guide. Of these, 37 analyzed changes in levels of use of health services, 15 focused on the influencing factors and barriers to access, and 1 studied both aspects. Most focused on specific diseases and the early stages of the pandemic, based on a review of records. Analyses of the impact on primary care services’ use, unmet needs or inequalities in access were scarce. A generalized reduction in the use of health services was described. The most frequent access barrier described for non-COVID-19 conditions related to the services was a lack of resources, while barriers related to the population were predisposing (fear of contagion, stigma, or anticipating barriers) and enabling characteristics (worse socioeconomic status and an increase in technological barriers). In conclusion, our results show a general reduction in services’ use in the early stages of the pandemic, as well as new barriers to access and the exacerbation of existing ones. In view of these results, more studies are required on the subsequent stages of the pandemic, to shed more light on the factors that have influenced access and the pandemic’s impact on equity of access.

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Section: Resultsmentioning

confidence: 99%

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Pujolar-Díaz

Oliver-Anglès

Vargas

et al. 2022

IJERPH

159

View full text Add to dashboard Cite

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“…Some Health and Welfare policy measures even discouraged non-urgent access to (pediatric) emergency departments (PED), and more generally any frontal visits to family physicians/pediatricians, which were not considered urgent. A substantial reduction in the number of pediatric referrals/admissions to PEDs has been globally reported in Singapore, USA, Italy, and Argentina (Chong et al, 2020;McBride et al, 2020;Ferrero et al, 2021;Finkelstein et al, 2021;Pepper et al, 2021).…”

Section: Reduction In Overall Pediatric Emergency Department Visitsmentioning

confidence: 99%

Otitis Media Practice During the COVID-19 Pandemic

Marom¹,

Pitaro

Shah

et al. 2022

Front. Cell. Infect. Microbiol.

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The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.

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“…Given our limited sample size, diagnosis-group specific analysis of MNS characteristics could not be performed, and our cohort notably included very few patients with pneumonia ( n = 6). This was likely secondary to the circumstance that a large proportion of patients included in this retrospective analysis were admitted during the early phase of the COVID-19 pandemic when overall pediatric admissions due to respiratory tract infections had declined [ 15 , 16 ]. Of note, two of the seven patients with an MRSA infection had been bacteremic while the MNS were negative, raising the concern about the MNS’s performance in pediatric patients in suspected sepsis.…”

Section: Discussionmentioning

confidence: 99%

Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening in Hospitalized Children with Acute Infectious Disease Syndromes

et al. 2021

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Studies in adults support the use of a negative methicillin-resistant Staphylococcus aureus (MRSA) nares screening (MNS) to help limit empiric anti-MRSA antibiotic therapy. We aimed to evaluate the use of MNS for anti-MRSA antibiotic de-escalation in hospitalized children (<18 years). Records of patients admitted between 1 January 2015 and 31 December 2020 with a presumed infectious diagnosis who were started on anti-MRSA antibiotics, had a PCR-based MNS, and a clinical culture performed were retrospectively reviewed. A total of 95 children were included with a median age (range) of 2 (0–17) years. The top three diagnosis groups were skin and soft tissue infections (n = 38, 40%), toxin-mediated syndromes (n = 17, 17.9%), and osteoarticular infections (n = 14, 14.7%). Nasal MRSA colonization and growth of MRSA in clinical cultures was found in seven patients (7.4%) each. The specificity and the negative predictive value (NPV) of the MNS to predict a clinical MRSA infection were both 95.5%. About half (n = 55, 57.9%) had anti-MRSA antibiotics discontinued in-house. A quarter (n = 14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n = 21, 38.2%) after negative MNS test and negative culture results became available. A high NPV suggests that MNS may be useful for limiting unnecessary anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies are needed to further characterize the utility of MNS for specific infectious diagnoses.

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Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments

Abstract: Supplemental digital content is available in the text.

Cited by 59 publications

References 45 publications

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Otitis Media Practice During the COVID-19 Pandemic

Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening in Hospitalized Children with Acute Infectious Disease Syndromes

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