Initial effects of the COVID-19 pandemic on pediatric asthma emergency department utilization

Kenyon, Chén C.; Hill, David R.C.; Henrickson, Sarah E.; Bryant-Stephens, Tyra; Zorc, Joseph J.

doi:10.1016/j.jaip.2020.05.045

Cited by 151 publications

(175 citation statements)

References 5 publications

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“…Given that COVID-19 is a respiratory pathogen, we anticipated an increase in asthma exacerbations and new presentations. However, instead, we observed an impressive decline in the relative proportion of PED asthma presentations, similar to the recent findings reported by Kenyon et al [ 28 ] in other regions of the country. While we cannot conclude if patients self-treated at home or did not have exacerbations at all, we suspect that the same aforementioned factors influencing volume decline played a role in reducing asthma presentations.…”

Section: Discussionsupporting

confidence: 92%

“…Unique to our study, are the reported initial effects of a state phased re-opening on all PED trends in a known COVID-19 epicenter. Additionally, though Kenyon et al recently described the effects of COVID-19 on PED asthma visits [ 28 ], this study attempts to describe these effects beyond the pandemic peak, at a known asthma and COVID-19 epicenter.…”

Section: Introductionmentioning

confidence: 99%

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The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter

Levene

Fein

Silver

et al. 2021

The American Journal of Emergency Medicine

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Background: The Bronx has the highest prevalence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening. Objectives: To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019. Methods: Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 -July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared. Results: 19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p < 0.0001) and minor medical problems (61% vs. 67%, p < 0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p < 0.0001), appendicitis (1% vs. 0.4%, p < 0.0001) and other surgical complaints (1% vs. 0.5%, p < 0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. Conclusion:The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter

Levene

Fein

Silver

et al. 2021

The American Journal of Emergency Medicine

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“…We found that public health interventions designed to limit SARS-CoV-2 transmission in the Philadelphia region were associated with increased VTM and decreased overall asthma encounters, systemic steroid prescriptions, and RV positivity in our ED ( Figure 5 ). We previously noted an overall decrease in ED utilization at CHOP, 32 a pattern consistent with that observed in other regions of the country, which included a shift away from in-person care and toward VTM-based care. 33 Our observed decrease in the overall asthma disease burden is also consistent with national survey data.…”

Section: Discussionsupporting

confidence: 84%

Pediatric Asthma Health Care Utilization, Viral Testing, and Air Pollution Changes During the COVID-19 Pandemic

Taquechel

Diwadkar

Sayed

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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119

139

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Background The coronavirus disease 2019 (COVID-19) pandemic caused dramatic changes in daily routines and health care utilization and delivery patterns in the United States. Understanding the influence of these changes and associated public health interventions on asthma care is important to determine effects on patient outcomes and identify measures that will ensure optimal future health care delivery. Objective We sought to identify changes in pediatric asthma-related health care utilization, respiratory viral testing, and air pollution during the COVID-19 pandemic. Methods For the time period January 17 to May 17, 2015 to 2020, asthma-related encounters and weekly summaries of respiratory viral testing data were extracted from Children's Hospital of Philadelphia electronic health records, and pollution data for 4 criteria air pollutants were extracted from AirNow. Changes in encounter characteristics, viral testing patterns, and air pollution before and after Mar 17, 2020, the date public health interventions to limit viral transmission were enacted in Philadelphia, were assessed and compared with data from 2015 to 2019 as a historical reference. Results After March 17, 2020, in-person asthma encounters decreased by 87% (outpatient) and 84% (emergency + inpatient). Video telemedicine, which was not previously available, became the most highly used asthma encounter modality (61% of all visits), and telephone encounters increased by 19%. Concurrently, asthma-related systemic steroid prescriptions and frequency of rhinovirus test positivity decreased, although air pollution levels did not substantially change, compared with historical trends. Conclusions The COVID-19 pandemic in Philadelphia was accompanied by changes in pediatric asthma health care delivery patterns, including reduced admissions and systemic steroid prescriptions. Reduced rhinovirus infections may have contributed to these patterns.

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“…A retrospective review of pediatric asthma admissions in Slovenia from March to April noted a 71%–78% decrease in hospital asthma admissions compared to the same time period over the last 3 years as well as a 51%–68% decrease in admissions for acute respiratory tract infections 18 . A retrospective review of asthma visits to a Children's Emergency Department (ED) in the Northeastern United States in the spring of 2020 also noted a 76% lower than pre‐COVID ED utilization 19 . The reasons for this are unknown, and require further validation, but are hypothesized to be related to reduced outdoor aeroallergen exposure, reduced traffic/industrial pollution, reduction in viral triggers, and improved air quality during the lockdown.…”

Section: Coronavirus Disease‐2019 In Children With Asthmamentioning

confidence: 99%

Pediatric asthma and COVID‐19: The known, the unknown, and the controversial

Abrams

Sinha

Fernandes

et al. 2020

Pediatric Pulmonology

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The novel coronavirus disease‐2019 (COVID‐19), caused by the pathogen severe acute respiratory syndrome‐CoV‐2, is causing a global pandemic, with over 26.9 million cases and 880,000 deaths as of September 6, 2020. While there has been speculation and observational research about the impact of COVID‐19 on asthma, much remains unknown. The goal of this article is to provide a scoping review on pediatric asthma and COVID‐19 and summarize what we do and do not know from the first wave of the pandemic.

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Initial effects of the COVID-19 pandemic on pediatric asthma emergency department utilization

Cited by 151 publications

References 5 publications

The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter

The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter

Pediatric Asthma Health Care Utilization, Viral Testing, and Air Pollution Changes During the COVID-19 Pandemic

Pediatric asthma and COVID‐19: The known, the unknown, and the controversial

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