Nonurgent Visits to the Pediatric Emergency Department before and during the First Peak of the COVID-19 Pandemic

Abstract

Background. Nonurgent visits in pediatric Emergency Departments are a growing burden. In order to find predictors for those nonurgent visits, we performed a retrospective analysis of unscheduled visits at the Pediatric Emergency Department of the University Hospital of Bonn, Germany, in the year 2017. Additionally, we compared these findings to unscheduled visits during the first peak of the worldwide pandemic of the Coronavirus disease 2019, to see if there would be an effect on nonurgent pediatric Emergency Department attendances. Methods. For our retrospective cohort study, we analyzed more than 5.000 visits at the pediatric Emergency Department of the University Hospital of Bonn, Germany, before and during the first peak of the ongoing worldwide pandemic of the Coronavirus disease 2019, particularly with regard to their urgency. Data included gender, age, zip code, urgency, and preexisting conditions. Results. Our study shows that more than half of unscheduled pediatric Emergency Department visits (69%) at the University Hospital in Bonn are for nonurgent reasons, with short living distance being a factor to present children to a pediatric Emergency Department, even with minor complaints. During the first peak of the pandemic of the Coronavirus disease 2019, nonurgent visits decreased significantly, potentially due to hesitation to attend a pediatric Emergency Department with minor issues, fearing an infection with SARS-CoV-2 at the hospital. Conclusion. Many people use pediatric Emergency Departments for nonemergency complaints. In order to address the reasons for nonurgent visits to pediatric Emergency Departments and to prevent parents from doing so, further studies and targeted education concepts for parents are needed.

Distances to emergency departments and non-urgent utilization of medical services: a systematic review

“…With the exception of five studies [ 10 , 15 , 37 , 38 , 40 ], all reviewed studies were cross-sectional in nature. Seven studies collected primary data [ 5 , 30–32 , 34 , 35 , 39 ] while eight studies relied on secondary data [ 9 , 10 , 15 , 33 , 36–38 , 40 ]. All studies were published between 1978 and 2023, and conducted in North America (USA [ 10 , 15 , 30 , 34 , 37 , 40 ] and Canada [ 39 ]), Europe (Italy [ 9 , 35 ], Belgium [ 32 ], Germany [ 33 ], Portugal [ 38 ], France [ 5 ], Turkey [ 31 ]), and Korea [ 36 ].…”

“…Seven studies collected primary data [ 5 , 30–32 , 34 , 35 , 39 ] while eight studies relied on secondary data [ 9 , 10 , 15 , 33 , 36–38 , 40 ]. All studies were published between 1978 and 2023, and conducted in North America (USA [ 10 , 15 , 30 , 34 , 37 , 40 ] and Canada [ 39 ]), Europe (Italy [ 9 , 35 ], Belgium [ 32 ], Germany [ 33 ], Portugal [ 38 ], France [ 5 ], Turkey [ 31 ]), and Korea [ 36 ]. All the studies examined the role of distance on the utilization of non-urgent services in the ED.…”

“…A variety of methods were used to identify non-urgent visits across the fifteen studies. Six studies used an algorithm, such as the New York University – Emergency Department Algorithm (NYU-EDA) [ 10 , 37 , 40 ], the Manchester Triage System Algorithm [ 33 , 38 ], or the Pediatric Canadian Triage and Acuity Scale (PCTAS) [ 31 ], to define and select non-urgent ED visits. One study used primary diagnosis codes to define non-traumatic dental conditions seen in the ED [ 15 ].…”

“…Of all the studies, one reported measuring distance as ‘travel distance’ using Google maps to determine the shortest road distance traveled by patients [ 36 ], while others estimated distance as reported by the study participants in the surveys [ 5 , 31 , 34 , 35 ]. Additionally, two studies reported travel time based on the existing transportation networks, as reported by the study participants [ 30 , 32 ], while the remaining studies reported the average distance between the population centroid of a patient’s zip-code, municipality or census tract and the nearest ED facility [ 15 , 37 ] or the ED facility visited [ 33 , 38 , 39 ]. Based on where the study was conducted, distance was reported in miles (e.g.…”

“… 4) Those whose travel time was less than 30 minutes, had higher odds (OR = 1.7 [95% CI = 1.3–2.2) of visiting the ED than those with travel times of 30 minutes or more. Age , Disadvantaged family Hospital setting Out-of-hours visit Registered family doctor Guckert et al Germany, 2022 [ 33 ] Cohort study/ Pediatric patient-level study To determine factors leading to a non-urgent presentation at the ED before and during the first peak of the COVID-19 pandemic. January-December 2017; March-April 2020 Children 16 years or less visiting a single university hospital and residing within a geographic distance between 0–20 kms.…”