The impact of public health interventions on critical illness in the pediatric emergency department during the SARS‐CoV‐2 pandemic

Abstract

Study objective The impact of public health interventions during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic on critical illness in children has not been studied. We seek to determine the impact of SARS‐CoV‐2 related public health interventions on emergency healthcare utilization and frequency of critical illness in children. Methods This was an interrupted time series analysis conducted at a single tertiary pediatric emergency department (PED). All patients evaluated by a provider from December 31 through May 14 of 6 consecutive years (2015‐2020) were included. Total patient visits (ED and urgent care), shock trauma suite (STS) volume, and measures of critical illness were compared between the SARS‐CoV‐2 period (December 31, 2019 to May 14, 2020) and the same period for the previous 5 years combined. A segmented regression model was used to explore differences in the 3 outcomes between the study and control period. Results Total visits, STS volume, and volume of critical illness were all significantly lower during the SARS‐CoV‐2 period. During the height of public health interventions, per day there were 151 fewer total visits and 7 fewer patients evaluated in the STS. The odds of having a 24‐hour period without a single critical patient were >5 times higher. Trends appeared to start before the statewide shelter‐in‐place order and lasted for at least 8 weeks. Conclusions In a metropolitan area without significant SARS‐CoV‐2 seeding, the pandemic was associated with a marked reduction in PED visits for critical pediatric illness.

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

“…Likewise, the lack of contact with primary care physicians and pediatric subspecialty office closures may have increased acuity. In contrast, the relative proportional increase in acuity may in fact be due to a significant absolute decline among lower acuity patients [ 27 ], possibly resulting from an increase in self-management of non-emergent minor medical complaints at home.…”

“…To date, most data reported has focused on PED trends before and during the pandemic peak [ 14 , 15 , 18 , 26 ] and a recent study looking beyond the height of the pandemic was limited to critically ill children [ 27 ]. 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.…”

“…At the same time, an increase in patient acuity was reported, [4,15,[17][18][19]. While some studies have attributed this to a possible delay in seeking care due to intentional avoidance of health care facilities during the pandemic [16,19], Dean et al found a large absolute decrease in PED critical care patients during the pandemic period, despite representing a high proportion of overall visits [20]. Recently, Chaiyachati et al described the clinical profile of patients presenting to the PED at the Children's Hospital of Philadelphia before and during the pandemic peak.…”

Pediatric Emergency Department Visits at US Children’s Hospitals During the COVID-19 Pandemic

“…Furthermore, pediatric EDs serve as regional referral centers providing specialized care, but data characterizing the clinical and financial impact of the COVID-19 pandemic on this practice setting is limited. [14][15][16] Finally, current studies do not explore whether the decline in ED visits differentially impacted certain pediatric conditions or whether resource utilization differed for patients seeking ED care during the pandemic. 14,15 As SARS-CoV-2 cases continue to rise among children, [4][5][6] an improved understanding of the clinical and financial impact of the COVID-19 pandemic specifically on pediatric ED care is needed.…”

“…[14][15][16] Finally, current studies do not explore whether the decline in ED visits differentially impacted certain pediatric conditions or whether resource utilization differed for patients seeking ED care during the pandemic. 14,15 As SARS-CoV-2 cases continue to rise among children, [4][5][6] an improved understanding of the clinical and financial impact of the COVID-19 pandemic specifically on pediatric ED care is needed. [14][15][16][17] Thus, we describe the epidemiology of pediatric ED visits and resource utilization at tertiary care children's hospitals in the US during the first five months of the COVID-19 pandemic.…”