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Pediatric emergency revisits of children with COVID-19
Leman Akcan Yildiz1, Oznur Karaca Vural2, Ali Kansu Tehci2
1Pediatric Emergency Clinic, Ankara Bilkent City Hospital, Ankara, Turkey.
Insights
Pediatric COVID-19 patients may revisit the emergency department without worsening. Unnecessary revisits increase healthcare costs and workload, suggesting a need for clinical assessment over extensive testing.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- Children diagnosed with COVID-19 (coronavirus disease 2019) can present with mild symptoms.
- Understanding patterns of emergency department revisits is crucial for optimizing pediatric care.
Purpose of the Study:
- To characterize pediatric emergency revisits in COVID-19 patients.
- To identify factors associated with clinical worsening and hospitalization upon revisit.
Main Methods:
- Retrospective study of pediatric emergency visits for COVID-19 between July 2020 and March 2021.
- Inclusion criteria: revisit within 7 days of initial presentation.
- Analysis of demographic, clinical characteristics, and test results in relation to revisit outcomes.
Main Results:
- 284 out of 6779 (4.1%) COVID-19 pediatric patients had a revisit within 7 days.
- Hospitalization rates at revisit were 14.7%, with younger children (<24 months) and those with chronic diseases at higher risk.
- Increased laboratory and radiologic testing at revisit did not significantly influence decision-making; most patients remained clinically mild.
Conclusions:
- Pediatric COVID-19 patients may revisit the emergency department without significant clinical deterioration.
- Preventing unnecessary revisits can reduce healthcare system workload and costs.
- Clinical findings should be prioritized over extensive testing for revisit patient management.
Objective:
This study was conducted to reveal the characteristics of pediatric emergency revisits of children with COVID-19 and the factors associated with clinical worsening and hospitalization at the revisit.
Materials And Methods:
In pediatric emergency visits of children between July 2020 and March 2021 with COVID-19, the patients who had a revisit within 7 days were included in the study. Demographic and clinical characteristics, test results, and the relationship of these variables with clinical worsening and hospitalization at the revisit were investigated.
Results:
In 6779 children with COVID-19, 284 (4.1%) patients included in the study. 51.8% of the patients were male, the median age was 11.1 years, and median time to revisit time was 2.0 days. The rates of clinical worsening and hospitalization were 9.1% and 14.7%, respectively. Children younger than 24 months and those with chronic diseases were more commonly hospitalized at the revisit. Though the frequency of laboratory and radiologic testing at the revisit was significantly increased compared to the first presentation, tests did not play an important role in the decision-making processes. More than 85% of patients were clinically mild at the first presentation and revisit.
Conclusions:
Children with a diagnosis of COVID-19 can revisit the emergency without evident clinical worsening. Since revisits cause increase in frequency of laboratory and radiological testing, preventing unnecessary revisits of children with COVID-19 can reduce the workload and cost of health care services. We may consider changing our perspective on revisit patients to make decisions based on clinical findings instead of obtaining for more laboratory tests.
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