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The ongoing indirect effect of the COVID-19 pandemic on a pediatric emergency department
Matti Erlichman1, Todd Zalut2, Shepard Schwartz1
1Shaare Zedek Medical Center and the Faculty of Medicine at the Hebrew University in Jerusalem, Pediatric Emergency Department, Jerusalem, Israel.
Insights
The COVID-19 pandemic significantly reduced pediatric emergency department visits, yet hospitalization rates increased during lockdowns. This trend persisted post-lockdown, emphasizing the need for public awareness regarding children's emergency care.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- The COVID-19 pandemic has impacted healthcare delivery, particularly pediatric emergency departments (PEDs).
- Understanding the pandemic's effect on children's healthcare access is crucial.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic and associated social restrictions on PED visits and hospitalizations.
- To compare trends with adult emergency departments (EDs) and analyze changes over time relative to pandemic severity.
Main Methods:
- Retrospective analysis of daily PED and adult ED visits and hospitalizations at Shaare Zedek Medical Center from January to July 2018-2020.
- Comparison of hospitalization risk ratios and incidence rate ratios between 2019 and 2020.
Main Results:
- During March-April 2020, PED visits decreased by 45% compared to 2019, with a 31% increase in hospitalization risk ratio.
- Adult EDs showed similar, though less pronounced, trends.
- From May-July 2020, PED visits remained 30% below pre-pandemic levels, while hospitalization rates normalized.
Conclusions:
- A significant decline in pediatric emergency visits extended beyond the initial lockdown period.
- This highlights a potential risk of delayed medical attention for critically ill children.
- Public awareness campaigns are essential to ensure children receive timely care during health crises.
Introduction:
The SARS-CoV-2 coronavirus pandemic may cause significant morbidity and mortality in adults, yet severe cases are rare among children. The indirect impact of the pandemic on health care delivery in general and pediatric emergency department (PED) visits in particular has been widely reported.
Aims:
To assess the impact of the pandemic and the social restrictions imposed in its wake on PED visits and hospitalization rates in our Israeli medical center. We also sought to track these data in relation to the variation in pandemic severity and social restrictions over time. A comparison of this data with that of the adult emergency department was also performed.
Methods:
Data for this study were drawn from the Shaare Zedek Medical Center (SZMC), Jerusalem, Israel computerized databank. The daily number of PED and adult ER visits as well as hospitalizations resulting from these visits during the months January-July during the years 2018, 2019, 2020 were recorded. We compared the risk ratio for hospitalization in 2019 and 2020, as well as the incidence rate ratio.
Results:
During March and April there was a decrease in PED visits from 4,588 visits in 2019 to 2,527 visits in 2020 (ratio = .551, 95%CI [.52,.58]. Despite the drop in PED visits, the rate of hospitalizations rose with respect to 2019 (Risk Ratio = 1.31, p < .001, 95%CI [1.17,1.47]). Similar but more moderate trends were seen in the adult ED. From May-July 2020, after the lockdown was lifted, PED visits remained 30% below the same time period from 2018 and 2019, while the hospitalization rate returned to its pre-pandemic level.
Conclusions:
A significant drop in PED visits is seen to extend well beyond the peak of the pandemic and the lockdown period. This highlights the potential risk of children with serious emergencies becoming casualties of the pandemic by their not being brought to medical attention. Efforts should be made to raise public awareness among parents and other caretakers of children regarding this matter.
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