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Changing patterns of emergency paediatric presentations during the first wave of COVID-19: learning for the second
Dhurgshaarna Shanmugavadivel1,2, Jo-Fen Liu3, Colin Gilhooley2,4
1Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK.
Insights
The COVID-19 pandemic reduced pediatric emergency department visits by 50%, with significant shifts in illness presentations like abdominal pain and fever. Further research and public health guidance are needed for children and young people (CYP).
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Infectious Disease Epidemiology
Background:
- The COVID-19 pandemic significantly altered healthcare delivery and utilization.
- Children and young people (CYP) experienced a lower burden of SARS-CoV-2 illness.
- Understanding changes in pediatric emergency care during the pandemic is crucial for public health interventions.
Purpose of the Study:
- To compare pediatric emergency department (ED) presentation patterns during the initial COVID-19 pandemic response with a pre-pandemic period.
- To inform effective child public health strategies and interventions.
- To analyze changes in illness and injury presentations among children and young people.
Main Methods:
- Retrospective review of ED attendances for individuals aged 0-18 years.
- Comparison of data from the initial pandemic period (March-May 2020) with 2019 data.
- Analysis of referral source, presenting complaint, diagnosis, and disposal, with subgroup analysis by age, sex, ethnicity, and pandemic phase.
Main Results:
- Total pediatric ED attendances decreased by 50% during the pandemic, with a maximum reduction of 73% in the second week of lockdown.
- The ranking of top illness presentations shifted, with breathing difficulties decreasing and abdominal pain and fever increasing in prominence.
- Despite the reduction in visits, the acuity of illness presentations did not significantly change.
Conclusions:
- A 50% reduction in pediatric ED visits occurred during the pandemic, but illness acuity remained stable.
- Shifts in the rank order of common pediatric illnesses, notably the rise of abdominal pain and fever, warrant further investigation.
- Development of CYP-specific public health messaging and primary care guidance is essential for the second wave to ensure appropriate access to emergency services.
Background:
The SARS-CoV-2 pandemic and initial public health response led to significant changes in health service delivery, access and utilisation. However, SARS-CoV-2 illness burden in children and young people (CYP) is low. To inform effective child public health interventions, we aimed to compare patterns of paediatric emergency department presentation during the initial pandemic response with a previous non-pandemic period.
Methods:
Retrospective review of attendances (0-18 years) over the initial pandemic (2 March 2020-3 May 2020) compared with 2019. Outcome measures included number of attendances, referral source, presenting complaint, discharge diagnosis and disposal. Descriptive statistics with subgroup analysis by age/sex/ethnicity and pandemic time periods (pre-lockdown, lockdown weeks 1-3 and lockdown weeks 4-6) was performed.
Results:
4417 attendances (57% illness and 43% injuries) occurred, compared with 8813 (57% illness and 43% injuries), a reduction of 50%, maximal in lockdown week 2 (-73%). Ranking of top three illness presentations changed across the pandemic weeks. Breathing difficulty dropped from first (300, 25%) to second (117, 21%) to third (59, 11%) (p<0.001). Abdominal pain rose from the third pre-lockdown (87, 7%) and lockdown weeks 1-3 (37, 7%) to second in weeks 4-6 (62, 12%; p=0.004). Fever ranked second (235, 19%) in pre-lockdown and first in weeks 1-3 (134, 24%) and weeks 4-6 (94, 18%; p=0.035).
Conclusions:
Despite a 50% reduction, there was no significant change in acuity of illness. Rank of illness presentations changed, with abdominal pain ranking second and fever first, an important change from previous, which should prompt further research into causes. CYP-specific public health messaging and guidance for primary care are required in this second wave to ensure access to appropriate emergency services.
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