Italian COVID-19 epidemic: effects on paediatric emergency attendance—a survey in the Emilia Romagna region

Cella, Andrea; Marchetti, Federico; Biase, Anna Rita Di; Graziani, Giulia; Fanti, Alessandro De; Valletta, Enrico; Vaienti, Francesca; Vergine, Gianluca; Viola, Laura; Biasucci, Giacomo

doi:10.1136/bmjpo-2020-000742

Cited by 19 publications

(26 citation statements)

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“…We found a steep drop in infection-related attendances, particularly upper and lower respiratory infections, which was consistent with local national epidemiological data [ 32 ], as well as reported trends from other EDs [ 29 ]. Lockdown measures would have reduced the transmission of air-borne and droplet-transmitted diseases of all causes.…”

Section: Discussionsupporting

confidence: 91%

“…There was a corresponding increase in the proportion of traumarelated cases. The sharp decline in the overall number of cases seen during the pandemic is consistent with other published reports, which have attributed this phenomena to social 95%CI 95% confidence interval distancing measures that reduced the rate of transmission of infections, as well as public fear of visiting healthcare institutions [28][29][30]. In our institution, this decline in attendance has not been seen in previous years and cannot be attributed to seasonal changes in ED attendances.…”

Section: Discussionsupporting

confidence: 90%

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Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore

et al. 2020

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Background Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore. Methods We performed a retrospective review of ED attendances and hospital admissions among children < 18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs). Results We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline (p < 0.001), attributed largely to a drop in respiratory (% change − 87.9, 95% CI − 89.3 to − 86.3, p < 0.001) and gastrointestinal infections (% change − 72.4, 95%CI − 75.9 to − 68.4, p < 0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change − 40.0, 95%CI − 44.3 to − 35.3, p < 0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p < 0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change − 73.9, 95%CI − 75.9 to − 71.7, p < 0.001). Conclusions We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore

et al. 2020

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“…There was a significant reduction in the number of attendances to the ED, which correlates with other published literature worldwide. [5][6][7][8][9][10] The reason for this is likely to be largely due to public health messaging instructing the public to 'stay at home, protect the NHS, save lives', 16 as well as the fear of contracting the illness from the hospital and the indirect consequences of staying at home. There was little change in the acuity of attendances, namely, the severity of illness, sources of referral and disposal.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Initial public health messaging during the first wave focused on reducing the overall burden on health services to release capacity to manage patients with SARS-CoV-2 illness. Attendances to the paediatric emergency department (ED) were noted to decline considerably across the UK, 5 6 Ireland 7 and worldwide, [8][9][10][11] while media campaigns urged the public to stay at home to reduce What is known about the subject?…”

mentioning

confidence: 99%

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

Shanmugavadivel

Liu

Gilhooley

et al. 2021

bmjpo

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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.

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“…As with all outbreaks, the Emergency Department (ED) has been the primary portal of entry into hospitals for COVID-19 patients [3][4][5] . Despite the surge in suspected COVID-19 cases, there is global evidence to show that the Emergency Department (ED)'s overall daily attendance has declined [6][7][8][9][10][11] . Several studies have reported signi cant reductions in visits associated with time-sensitive and life-threatening conditions such as acute myocardial infarction and stroke [12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

Lim

Siddiqui

Liu

et al. 2021

Preprint

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Introduction: It is yet to be understood how COVID-19 impacted utilisation of Emergency Department (ED) services in Singapore. This study aimed to describe the changes in attendance of a single ED and corresponding patient visit characteristics and outcomes before and during the COVID-19 period.Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019).Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by reductions in P1 visits and presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Average ED admission rate during the Circuit Breaker period (48.3%) was higher as compared to pre-Circuit Breaker period (40.7%), however average daily admission remained stable.Conclusion: The COVID-19 pandemic caused a reduction in SGH ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. Our data provides insights that may be useful for ED crowd management planning in the post-COVID-19 era. There should be cautious use of ED admission rate as a metric in evaluating ED performance during an outbreak.

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Italian COVID-19 epidemic: effects on paediatric emergency attendance—a survey in the Emilia Romagna region

Cited by 19 publications

References 5 publications

Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore

Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore

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

A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

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