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Influence of epidemics and pandemics on paediatric ED use: a systematic review
Damian Roland1,2, Adam Gardiner3, Darakhshan Razzaq4
1SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK dr98@leicester.ac.uk.
Insights
Epidemics and pandemics significantly alter paediatric emergency care use. Fear of infection or severe outcomes drives changes in emergency department visits, impacting health policy decisions.
Area of Science:
- Public Health
- Epidemiology
- Pediatric Emergency Medicine
Background:
- Epidemics and pandemics pose significant challenges to healthcare systems globally.
- Understanding their impact on pediatric emergency care utilization is crucial for effective health policy.
- Previous research has not comprehensively synthesized these effects.
Conclusions:
- The impact of epidemics on PED utilization varies based on the disease, public health measures, and public fear.
- Public fear of contracting diseases or their outcomes influences healthcare-seeking behavior.
- Inconsistent reporting of epidemic impacts on PED use requires attention for future policy development.
Objective:
To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice.
Setting:
Systematic review.
Design:
Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO).
Patients:
Children under 18 years.
Interventions:
National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used.
Main Outcome Measures:
Changes in paediatric emergency care utilisation.
Results:
131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively.
Conclusions:
The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed.
Trial Registration Number:
CRD42021242808.
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