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Six Diagnoses of Separation: Impact of COVID-19 on Pediatric Emergency Department Visits: A Multicenter Study
Shruthi Rethi1, Neeraja Kairam2, Christopher S Amato2
1Department of Pediatrics, Morristown, New Jersey.
Insights
Pediatric emergency department visits for common conditions like asthma and appendicitis significantly decreased during the COVID-19 pandemic due to quarantine measures and virus fears. This study analyzed trends in pediatric emergency visits for six key diagnoses before and during the pandemic.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Epidemiology
- Public Health Policy
Background:
- The COVID-19 pandemic prompted widespread self-quarantine and reduced healthcare visits to limit viral spread.
- This led to an observed decrease in overall pediatric emergency department (ED) visits.
- The impact on specific common pediatric diagnoses remained unclear.
Purpose of the Study:
- To investigate the effect of the COVID-19 pandemic on the frequency of common pediatric diagnoses presenting to the ED.
- To analyze changes in pediatric ED visits for anxiety, appendicitis, asthma, headaches, seizures, and urinary tract infections (UTIs) before and during the pandemic.
Main Methods:
- A retrospective cohort study was conducted using data from 28 hospital EDs near New York City.
- Pediatric patient data (age ≤ 21 years) from March 1 to November 30, 2019, and 2020, were analyzed.
- The number of visits for specific diagnoses was compared between the two periods.
Main Results:
- Total pediatric ED visits decreased by 61% from 2019 to 2020.
- Significant reductions were observed for asthma (75%), headaches (64%), urinary tract infections (47%), anxiety (32%), seizures (28%), and appendicitis (18%).
- All observed decreases were statistically significant (p < 0.0001).
Conclusions:
- The COVID-19 pandemic was associated with a substantial decline in pediatric ED visits for several common diagnoses.
- Quarantine recommendations and public fear of contracting COVID-19 are suspected reasons for reduced healthcare-seeking behavior.
- Further research is needed to explore the implications of delayed care for other pediatric conditions.
Background:
Coronavirus disease 2019 (COVID-19) arrived in the New York metropolitan area in early March 2020. Recommendations were made to self-quarantine within households and limit outside visits, including those to clinics and hospitals, to limit the spread of the virus. This resulted in a decrease in pediatric emergency department (ED) visits. However, it is unclear how this affected visits for some common diagnoses such as anxiety, appendicitis, asthma, headaches, seizures, and urinary tract infection (UTI). These diagnoses were chosen a priori, as they were felt to represent visits to the ED, for which the diagnoses would likely not be altered based on COVID exposure or quarantine due to their acute nature.
Objectives:
Our goal was to investigate the effect of COVID-19 on common pediatric diagnoses seen in the pediatric ED using a large multihospital database.
Methods:
We conducted a retrospective cohort study of consecutive pediatric patients (age ≤ 21 years) between March 1 and November 30 in 2019 and 2020 in 28 hospital EDs within 150 miles of New York City. We compared the change in the number of visits from 2019 to 2020 for the following diagnoses: anxiety, appendicitis, asthma, headache, seizures, and UTI.
Results:
Our database contained 346,230 total pediatric visits. From 2019 to 2020, total visits decreased by 61%. Decreases for specific diagnoses were 75% for asthma, 64% for headaches, 47% for UTI, 32% for anxiety, 28% for seizures, and 18% for appendicitis (p value for each comparison < 0.0001).
Conclusions:
We found a marked decrease in ED visits for six common pediatric diagnoses after COVID-19 arrived in our area. We suspect that this decrease was due to recommendations to quarantine and fear of contracting the virus. Further studies on other diagnoses and potential complications due to the delay in seeking care are needed.
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