Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study

Abstract

Background COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders. Methods Impact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs. All the children <18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019. Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children. Findings 16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%). Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) ( P <0·0001). Admissions with low priority decreased more than critical ones (-82·77% vs. 44·17% respectively; P <0·0001). Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) ( P <0·0001). No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs. 57·28% respectively; P = 0·2344). Interpretation Admissions with low priority decreased significantly more than those with high priority; we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers. Compared to 2019, no significant referral delay by caregivers was reported. Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic.

Pediatric emergency department visits during the COVID-19 pandemic: a large retrospective population-based study

“…These findings suggest that the measures taken by the central government to contain the pandemic had a profound impact on the use of EDs, as well as on other healthcare services. They led to a sharp drop (− 48%) in all medical consultations compared with 2019, especially during the lockdown, when they decreased by 79% compared to the same months of the previous year, with a similar magnitude to that reported previously [ 30 ]. While the reduction in ED visits was more pronounced during the first and second waves of the pandemic, even with the loosening of restrictions during summer, they did not return to pre-pandemic levels.…”

“…It is an issue of concern, however, that parents might have avoided seeking hospital-based services for fear of contagion. This impression is supported by the greater proportion of urgencies and emergencies in 2020, indicating a general tendency of children to be presented at the ED for more severe conditions, as observed by a previous Italian study [ 30 ]. This is further confirmed by the 9.1% of pediatric patients arriving at the ED in 2020 being hospitalized, with a sharp increase compared to the 5.9% recorded in 2019.…”

“…To the best of our knowledge, few studies have examined in detail the effect of the COVID-19 pandemic on the trends of pediatric ED visits over two years. Many papers focused exclusively on ED admissions under lockdown, and very few studies were population-based [ 24 – 30 ].…”

Presidential address—the Black Swan: ISPN and pediatric neurosurgery in times of COVID-19

“…Although rarely affected by the virus itself, due to the lockdown imposed in most of the countries, children presented with mood and behavior changes leading to longlasting psychological or psychiatric disorders [14,15]. Older children were specially impacted by the closure of schools and introduction of digital home schooling, although changes induced by the public health crisis, social isolation, and economic recession could affect all the family clusters [16,17].…”

“…Fewer outdoor activities and school closure led to a significant decrease in the number of fractures requiring surgery but, conversely, it lead to an increase in domestic trauma [30]. Reduction in activity away from home may be a reasonable explanation for the drop in trauma referrals since parents and patients feared to go to the hospital [14,24]. The reduction of referral may also be ascribed to the lower number of trivial or ill-identified problems [28] and also the implementation of virtual consultations [27].…”