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Changes in paediatric Ambulatory Care Sensitive Conditions in Victoria, 2018-20: the COVID-19 effect?
Mary White1, Simon Craig2, Wanyu Chu3
1Health Services Research Unit, The Royal Children's Hospital, Parkville, Melbourne, Vic., Australia; and Department of Endocrinology & Diabetes, The Royal Children's Hospital, Parkville, Melbourne, Vic., Australia; and Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Vic., Australia.
Insights
During COVID-19 restrictions, emergency department visits for pediatric Ambulatory Care Sensitive Conditions (ACSCs) in Victoria decreased significantly. Importantly, the severity of these pediatric ACSC presentations did not increase, suggesting no rise in delayed care.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Epidemiology
Background:
- Ambulatory Care Sensitive Conditions (ACSCs) in children can indicate issues with out-of-hospital care.
- The COVID-19 pandemic and associated restrictions may have altered healthcare-seeking behaviors and care access for pediatric conditions.
Purpose of the Study:
- To analyze trends in emergency department (ED) presentations and hospital admissions for pediatric ACSCs in Victoria, Australia, before and during COVID-19 restrictions.
- To determine if pandemic-related changes in out-of-hospital care led to more severe or delayed pediatric presentations.
Main Methods:
- Secondary analysis of the Victorian Emergency Minimum Dataset and Victorian Admitted Episode Dataset.
- Inclusion of pediatric patients (<18 years) with ACSC diagnoses.
- Comparison of presentation numbers and severity (urgency, admission rates) pre-COVID-19 (Jan 2018–Mar 2020) and during COVID-19 (Mar–Oct 2020).
- Utilized a linear regression prediction model to compare observed vs. predicted 2020 presentation numbers.
Main Results:
- A total of 108,104 pediatric ACSC ED presentations were analyzed.
- A significant decrease in ED presentations was observed in 2020 compared to previous years, particularly for viral-mediated childhood conditions like asthma and ear/nose/throat issues.
- The proportion of high-urgency presentations and those requiring hospital admission remained stable during the 2020 period.
Conclusions:
- Victorian emergency departments experienced a reduction in pediatric ACSC presentations and admissions during 2020.
- The findings indicate that the decrease in presentations did not correspond with an increase in delayed or more severe pediatric ACSC cases.
Abstract:
Objectives This study sought to describe the patterns in emergency department (ED) presentations and hospital admissions in children with Ambulatory Care Sensitive Conditions (ACSCs) before and during the coronavirus disease 2019 (COVID-19) pandemic restrictions in Victoria, Australia, to assess if changes in out-of-hospital care resulted in an increase in delayed/severe presentations. Methods This study involved secondary analysis of Victorian Emergency Minimum Dataset and Victorian Admitted Episode Dataset data. Patients (<18 years) attending EDs with a diagnosis of an ACSC were included. We compared the number and severity of ASCS presentations pre-COVID-19 (1January 2018-27 March 2020) and during COVID-19 (28 March-31 October 2020). A linear regression prediction model was built to compare the observed versus predicted presentation number in the 2020 period. Results In total, there were 108 104 paediatric ACSC ED presentations in Victoria during the study period. Females accounted for 51 462/108 104 (47.6%) of all presentations, with a median age of 3 years. A significant decrease in ED presentations was seen in 2020 (41 319 in 2018; 44 978 in 2019; and 21 807 until October 2020), predominantly due to reductions in conditions that are typically mediated by viruses in childhood (i.e. asthma, convulsions/epilepsy and ear, nose and throat conditions). The proportion of high-urgency presentations and those requiring admission was stable in 2020. Conclusions An overall reduction in the number of ED presentations and admissions with paediatric ACSCs was seen in Victoria in 2020, indicating that rates of delayed or more severe presentations did not occur as a result of changes in out-of-hospital care.
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