Emergency department utilisation by vulnerable paediatric populations during the <scp>COVID</scp>‐19 pandemic

Cheek, John A; Craig, Simon; West, Adam; Lewena, Stuart; Hiscock, Harriet

doi:10.1111/1742-6723.13598

Cited by 45 publications

(76 citation statements)

References 2 publications

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“…Similar patterns have been reported internationally, such as a 47.2% decrease in presentations to emergency departments in Victoria, Australia [9] and 70-90% reduction in attendances to five paediatric emergency departments in Italy compared to previous data [10] .…”

supporting

confidence: 86%

Changes in hospital prescribing activity at a specialist children’s hospital during the COVID-19 pandemic - an observational study

Vestesson

Alonso

Booth

et al. 2020

Preprint

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ObjectiveTo compare hospital activity, patient casemix and medication prescribing and administration before and during the COVID-19 emergency.DesignRetrospective observational studySettingA specialist children’s hospital in the UKPatientsInpatients aged 25 and younger treated at a specialist children’s hospital between 29 April 2019 and 6 September 2020ResultsThere were 21,471 day cases and inpatients treated during the 16 month study period. Day cases (no overnight stay) dropped by around 37% per week. Both admissions and discharges for inpatients (at least one overnight stay) decreased leading to a small reduction in hospital bed days but no reduction in hospital bed nights. The effect on hospital activity on different patient groups varied substantially with some groups such as medical oncology day cases increasing by 13%. As a result, the patient case mix in the hospital was very different during the pandemic. Overall weekly medication administrations decreased for day cases and inpatients, but weekly medication administrations per bed day increased by 10% for day cases and 6% for inpatients.ConclusionsDespite not being badly affected by the disease itself, specialist paediatric hospital services have been greatly affected by the pandemic. The average number of medications per inpatient bed day increased, likely reflecting changes to the patient population, with only those children with severe conditions being treated during the pandemic. These data demonstrate the complex pattern of implications on specialist services and provide evidence for planning the impact of future emergencies and resolution strategies.

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supporting

confidence: 86%

Changes in hospital prescribing activity at a specialist children’s hospital during the COVID-19 pandemic - an observational study

Vestesson

Alonso

Booth

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Finally, it is important to note that the pandemic and the accompanying lockdowns may also exhibit negative effects on mental health. For example, a 25% increase in diagnoses related to mental health and a 104% increase in admissions due to anorexia nervosa have been reported [ 51 , 52 ]. On the other hand, a 27% reduction in mental health–related diagnoses as reason for ED visits was reported in Ireland [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

et al. 2021

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The coronavirus disease 2019 pandemic has enormous impact on society and healthcare. Countries imposed lockdowns, which were followed by a reduction in care utilization. The aims of this study were to quantify the effects of lockdown on pediatric care in the Netherlands, to elucidate the cause of the observed reduction in pediatric emergency department (ED) visits and hospital admissions, and to summarize the literature regarding the effects of lockdown on pediatric care worldwide. ED visits and hospital admission data of 8 general hospitals in the Netherlands between January 2016 and June 2020 were summarized per diagnosis group (communicable infections, noncommunicable infections, (probable) infection-related, and noninfectious). The effects of lockdown were quantified with a linear mixed effects model. A literature review regarding the effect of lockdowns on pediatric clinical care was performed. In total, 126,198 ED visits and 47,648 admissions were registered in the study period. The estimated reduction in general pediatric care was 59% and 56% for ED visits and admissions, respectively. The largest reduction was observed for communicable infections (ED visits: 76%; admissions: 77%), whereas the reduction in noninfectious diagnoses was smaller (ED visits 36%; admissions: 37%). Similar reductions were reported worldwide, with decreases of 30–89% for ED visits and 19–73% for admissions.Conclusion: Pediatric ED utilization and hospitalization during lockdown were decreased in the Netherlands and other countries, which can largely be attributed to a decrease in communicable infectious diseases. Care utilization for other conditions was decreased as well, which may indicate that care avoidance during a pandemic is significant. What is Known:• The COVID-19 pandemic had enormous impact on society.• Countries imposed lockdowns to curb transmission rates, which were followed by a reduction in care utilization worldwide. What is New:• The Dutch lockdown caused a significant decrease in pediatric ED utilization and hospitalization, especially in ED visits and hospital admissions because of infections that were not caused by SARS-CoV-2.• Care utilization for noninfectious diagnoses was decreased as well, which may indicate that pediatric care avoidance during a pandemic is significant.

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“…The COVID‐19 pandemic continues to have a significant impact on Australian EDs 1–6 . Although the overall number of ED presentations has decreased, 5,6 substantial reforms have been required to optimise infection prevention and control (IPC) processes 7 . COVID‐19 case numbers remain low, but Victoria's ‘second wave’ has demonstrated the need for vigilance 8 …”

Section: Introductionmentioning

confidence: 99%

Epidemiology and clinical features of emergency department patients with suspected and confirmedCOVID‐19: A multisite report from theCOVID‐19 Emergency DepartmentQuality Improvement Project for July 2020 (COVED‐3)

O’Reilly

Mitchell

Mitra

et al. 2020

Emerg Medicine Australasia

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Objective The aim of this study was to describe the epidemiology and clinical features of patients presenting to the emergency department (ED) with suspected and confirmed COVID‐19. Methods The COVID‐19 Emergency Department (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from eight sites across Victoria and Tasmania for July 2020 (during Australia's ‘second wave’). All adult patients who met criteria for ‘suspected COVID‐19’ and underwent testing for SARS‐CoV‐2 in the ED were eligible for inclusion. Study outcomes included a positive SARS‐CoV‐2 test result and mechanical ventilation. Results In the period 1 to 31 July 2020, there were 30 378 presentations to the participating EDs and 2917 (9.6%; 95% CI: 9.3–9.9) underwent testing for SARS‐CoV‐2. Of these, 50 (2%) patients returned a positive result. Among positive cases, two (4%) received mechanical ventilation during their hospital admission compared to 45 (2%) of the SARS‐CoV‐2 negative patients (OR 1.7 [95% CI: 0.4–7.3], p = 0.47). Two (4%) SARS‐CoV‐2 positive patients died in hospital compared to 46 (2%) of the SARS‐CoV‐2 negative patients (OR 1.7 [0.4–7.1] p = 0.49). Strong clinical predictors of a positive result included self‐reported fever, non‐smoking status, bilateral infiltrates on CXR, and absence of a leucocytosis on first ED blood tests (p < 0.05). Conclusions In this prospective multi‐site study from July 2020, a substantial proportion of ED patients required SARS‐CoV‐2 testing, isolation and enhanced infection prevention and control precautions. Presence of SARS‐CoV‐2 on nasopharyngeal swab was not associated with death or mechanical ventilation. This article is protected by copyright. All rights reserved.

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Emergency department utilisation by vulnerable paediatric populations during the COVID‐19 pandemic

Cited by 45 publications

References 2 publications

Changes in hospital prescribing activity at a specialist children’s hospital during the COVID-19 pandemic - an observational study

Changes in hospital prescribing activity at a specialist children’s hospital during the COVID-19 pandemic - an observational study

The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

Epidemiology and clinical features of emergency department patients with suspected and confirmedCOVID‐19: A multisite report from theCOVID‐19 Emergency DepartmentQuality Improvement Project for July 2020 (COVED‐3)

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