Paediatric Attendances and Acuity in the Emergency Department during the COVID-19 Pandemic

Abstract

Aim: To investigate the difference in both numbers and acuity of presentations to the Paediatric Emergency Department (PED) during the peak time period of the current global SARS-CoV-2 pandemic. Design: This single centre retrospective observational study used routinely collected electronic health data to compare patient presentation characteristics between 21st March and 26th April 2020 compared to the equivalent time period in 2019. Results: There was a 90% decrease in attendances to PED, with a 10.23% reduction re-attendance rate. Children presenting were younger during the pandemic, with a median age difference of 2 years. They were more likely to present in an ambulance (9.63%), be admitted to hospital (5.75%) and be assigned the highest two Manchester triage categories (6.26%). There was a non-significant trend towards longer lengths of stay. The top 10 presenting complaints remained constant (although the order changed) between time periods. There was no difference in mortality or admission to PICU. Implications: Our data demonstrates that there has been a significant decrease in numbers of children seeking emergency department care. It suggests that presenting patients were proportionally sicker during the pandemic; however, we would argue that this is more in keeping with appropriate acuity for PED presentations, as there were no differences in PICU admission rate or mortality. We explore some of the possible reasons behind the decrease in presentations and the implications for service planning ahead of the winter months.

Impacts of school closures on physical and mental health of children and young people: a systematic review

“…Reductions in hospital admissions in COVID-19 studies ranged from 31%-75% in Italy, 26,27,38 45.0% in France, 91 45-60% in Finland, 34 and 68% in the USA 24 to 85.7% in the UK. 42 Another Italian study reported that admissions fell 9.5% in the weeks preceding lockdown (when schools closed) and 30.7% during full lockdown. 26 The proportions of ED presentations admitted during lockdown rose 13.2% in the UK 42 and 15.8% in USA 24 for ward admissions and 5.8% (1.9, 10.0) for paediatric intensive care in the UK, 42 with an Italian study reporting a 164% rise in the proportion of ED presentations admitted.…”

“…Eight were from China, 45,50,68,70,72-74,77 7 from other low and middle-income countries (LMIC; Turkey, 58,79 Pakistan, 25 India, 28,65 Brazil, 55 Bangladesh 76 ) and 13 from Italy, 23,26,27,32,35,38,49,56,78,81,84-86 21 from the UK, 22,29-31,37,39-42,44,47,48,54,60,62-64,69,87,89,90 12 from the USA, 24,43,46,51,57,59,66,67,71,75,92,94 and 1 study each from Ireland, 88 France, 91 Germany, 93 Greece, 80 Spain, 61 Finland, 34 Slovenia, 33 Israel, 82,83 Australia, 52 Canada 53 and Japan. 36…”

“…Fifteen high-quality studies (14 cohort; 1 pre-post study) reported change in healthcare use in single hospitals/regional centres during the first COVID-19 wave compared with historical control periods. 23,24,26-29,31,33-35,37,38,42,44,91 Four high-quality studies reported national data; one Italian cohort study of ED attendances, 32 one German pre-post study of diabetes presentations 93 and two UK cross-sectional studies of delayed presentations. 62,64…”

“…Reductions in Emergency Department (ED) attendances by CYP were consistently high across all countries with estimates from 64% in Finland, 34 67% in the USA, 24 68% in France, 91 and 67-84% in Italy, 23,26,27,32,35,38 to 89.3% in one UK study. 42 Attendances were reduced across most presentations, including fever and respiratory infections, 24,26,27,38,91 trauma and injuries 24,26,27,38 and burns, 37 although injuries increased as a proportion of all cases. 35,38 One Italian study provided data on the impact of school closures separately to full lockdown.…”

“…They reported that ED attendances fell 24.6% in 2.5 weeks before lockdown, during which schools closed for the final week, before falling 66.7% during full lockdown from 11 March. 26 Two HQ studies from the UK 42 and the US 24 reported that reductions in ED attendances were mainly for less acute presentations, whilst one Italian study reported a small non-significant rise in acute presentations. 27…”