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Coronavirus disease 2019 in the pediatric emergency department: unique considerations in preparation and response
Suzanne Beno1, Caitlin Ross, Tania Principi
1Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Pediatric emergency departments adapted to COVID-19 by modifying operations, using personal protective equipment (PPE), and enhancing care. Despite challenges, these departments successfully prepared for pediatric patients during the pandemic.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Epidemiology
- Public Health Response
Background:
- The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges for Pediatric Emergency Departments (PEDs).
- Children generally experience milder COVID-19 courses but can develop conditions like multisystem inflammatory syndrome in children (MIS-C).
- The pandemic impacted injury rates, emergency care utilization, and mental health, abuse, and neglect rates in children and youth.
Purpose of the Study:
- To review adaptations and challenges in PEDs during the COVID-19 pandemic.
- To focus on operational modifications, personal protective equipment (PPE) needs, resuscitation protocols, and clinical presentations in children.
- To examine the unintended effects of the pandemic on children and youth.
Main Methods:
- Review of adaptations and challenges in PED preparation and response.
- Focus on operational modifications, PPE, protected resuscitation, and clinical characteristics.
- Analysis of pandemic's effects on pediatric emergency care and child welfare.
Main Results:
- PEDs successfully prepared for the pandemic through significant adjustments.
- Key adaptations included enhanced screening, testing, consistent PPE use, and protected resuscitation.
- Technological advancements in communication and virtual care were implemented, with simulation playing a crucial role.
Conclusions:
- COVID-19 necessitated rapid adaptation in PEDs, leading to both challenges and advancements.
- Ongoing experience and research are vital for optimizing pediatric emergency care during pandemics.
- Future efforts should focus on clinical/operational care, training, and provider well-being.
Purpose Of Review:
Pediatric Emergency Departments (PEDs) have experienced unique considerations throughout the coronavirus disease 2019 (COVID-19) pandemic. We review the adaptations and challenges surrounding the preparation and response for pediatric emergency patients, with a specific focus on operational modifications, evolving personal protected equipment (PPE) needs, protected resuscitation responses, clinical characteristics in children, and the unintended effects on children and youth.
Recent Findings:
COVID-19 has thus far proven to have a milder course in children, with manifestations ranging from asymptomatic carriage or typical viral symptoms, to novel clinical entities such as 'COVID toes' and multisystem inflammatory syndrome in children (MIS-C), the latter associated with potentially significant morbidity. It has had an important effect on primary prevention, injury rates, reduced presentations for emergency care, and increased mental health, abuse and neglect rates in children and youth. PEDs have prepared successfully. The most significant adjustments have occurred with screening, testing, and consistent and effective use of PPE, along with protected responses to resuscitation, adaptations to maintain family-centered care, and technological advances in communication and virtual care. Simulation has been key to the successful implementation of many of these strategies.
Summary:
COVID-19 has pushed PEDs to rapidly adapt to evolving clinical and societal needs, with both resultant challenges and positive advances. Further experience and research will guide how in the face of a global pandemic we can further optimize the clinical and operational care of children and youth, ensure robust educational training programs, and maintain provider safety and wellness.
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