Trends in Pediatric Emergency Department Utilization after Institution of Coronavirus Disease-19 Mandatory Social Distancing

Chaiyachati, Barbara H.; Agawu, Atu; Zorc, Joseph J.; Balamuth, Fran

doi:10.1016/j.jpeds.2020.07.048

Cited by 115 publications

(180 citation statements)

References 21 publications

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“…In this study, we describe differences in patient and department characteristics during the COVID-19 pandemic compared to prior years. We noted a decrease in the absolute number of patients in the pandemic period, consistent with other published work [ [1] , [2] , [3] , [4] , [5] , [6] ]. We demonstrated higher acuity and admission rates.…”

supporting

confidence: 92%

“…Patient volumes in our pediatric emergency department (PED) decreased significantly after the initiation of public health interventions during the Covid-19 pandemic. Chaiyachati et al demonstrated decreased volumes in a US PED [ 1 ], and recent studies in other countries support this observation [ [2] , [3] , [4] , [5] , [6] ]. An understanding of patient and visit characteristics during pandemics can ensure PED preparedness during high-volume surges or atypical low-volumes.…”

mentioning

confidence: 86%

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Pediatric emergency department volumes and throughput during the COVID-19 pandemic

Even

Lipshaw

Wilson

et al. 2021

The American Journal of Emergency Medicine

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supporting

confidence: 92%

mentioning

confidence: 86%

Pediatric emergency department volumes and throughput during the COVID-19 pandemic

Even

Lipshaw

Wilson

et al. 2021

The American Journal of Emergency Medicine

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“…Efforts to mitigate disease transmission, such as social-distancing measures, state lockdowns and school and recreational space closures also altered the pediatric medical landscape [ 11 , 12 ]. All aspects of pediatric medical care experienced a decrease in volume worldwide [ 13 ], including a significant reduction in PED visits [ [14] , [15] , [16] , [17] , [18] ]. At the same time, an increase in patient acuity was reported, [ 4 , 15 , [17] , [18] , [19] ].…”

Section: Introductionmentioning

confidence: 99%

“…All aspects of pediatric medical care experienced a decrease in volume worldwide [ 13 ], including a significant reduction in PED visits [ [14] , [15] , [16] , [17] , [18] ]. 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 ].…”

Section: Introductionmentioning

confidence: 99%

“…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. With the exception of increased ingestions, chief complaints remained similar when compared to the 3 years prior, despite a dramatic decrease in volume and increase in acuity [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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

Levene

Fein

Silver

et al. 2021

The American Journal of Emergency Medicine

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Background: The Bronx has the highest prevalence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening. Objectives: To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019. Methods: Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 -July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared. Results: 19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p < 0.0001) and minor medical problems (61% vs. 67%, p < 0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p < 0.0001), appendicitis (1% vs. 0.4%, p < 0.0001) and other surgical complaints (1% vs. 0.5%, p < 0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. Conclusion:The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted.

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Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

Liang,

Wang,

Dahlen

et al. 2024

JAMA Netw Open

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IMPORTANCEUrinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes.OBJECTIVESTo examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity.DESIGN, SETTING, AND PARTICIPANTSThis retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021.EXPOSURETime periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021).MAIN OUTCOMES AND MEASURESThe primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis.RESULTSThe cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: −33.1% (95% CI, −39.4% to −26.1%) for all children and −52.1% (95% CI, −62.1% to −39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (−4.3%; 95% CI, −32.0% to 34.6% for all children) after the first 3 months of the pandemic.CONCLUSIONS AND RELEVANCEIn this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.

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Trends in Pediatric Emergency Department Utilization after Institution of Coronavirus Disease-19 Mandatory Social Distancing

Cited by 115 publications

References 21 publications

Pediatric emergency department volumes and throughput during the COVID-19 pandemic

Pediatric emergency department volumes and throughput during the COVID-19 pandemic

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

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

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