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Pediatric injury attendances in different population groups in Israel before, during, and after COVID-19 lockdowns: a
Tomer Bernstine1, Michael Edelstein2,3, Danna Krupik2,4
1Azrieli Faculty of Medicine, Bar Ilan University, Tsfat, Israel. tomerbernstine@gmail.com.
Insights
COVID-19 lockdowns in Israel reduced emergency department (ED) visits for injuries among children. However, the proportion of injuries among younger children increased, and minority group attendance decreased, highlighting varied health-seeking behaviors during emergencies.
Area of Science:
- Public Health
- Epidemiology
- Pediatric Emergency Medicine
Background:
- The COVID-19 pandemic and associated lockdowns significantly altered healthcare utilization patterns, including emergency department (ED) visits.
- Israel implemented three distinct lockdown periods between March 2020 and February 2021 to control COVID-19 spread.
- The impact of these lockdowns on pediatric injury-related ED attendance in Northern Israel remained largely unexamined.
Purpose of the Study:
- To analyze trends in pediatric emergency department (ED) attendance for injuries in Northern Israel before, during, and after COVID-19 lockdowns.
- To compare the volume and characteristics of injury-related ED visits among children aged 0-17 during lockdown periods versus pre-pandemic and post-lockdown intervals.
Main Methods:
- Retrospective analysis of anonymized medical records from Ziv Medical Center (ZMC) for children (0-17 years) presenting with injuries.
- Data collection spanned from January 1, 2018, to October 2, 2022, encompassing pre-lockdown, lockdown, and post-lockdown periods.
- Statistical comparison using chi-square tests was employed to evaluate changes in ED attendance volume, injury proportion, age distribution, ethnicity, and hospitalization rates.
Main Results:
- A total of 7,619 injury-related ED visits were analyzed. Overall attendance volume decreased during lockdowns compared to pre-pandemic years.
- The proportion of injuries among all ED visits increased during lockdowns (67.8% vs. 52.7%), with a notable rise in injuries among 0-4 year olds (39.68% vs. 30.7%).
- Attendance from minority populations decreased during lockdowns (27.47% vs. 30.71%), while hospitalization rates for injuries increased (13.21% vs. 10.65%).
Conclusions:
- COVID-19 lockdowns led to a reduced volume of pediatric injury-related ED visits, but a higher proportion of these visits involved younger children.
- The decreased attendance from minority groups suggests potential disparities in healthcare-seeking behaviors during public health emergencies.
- Findings underscore the need for tailored public health strategies and emergency preparedness plans that consider diverse population needs.
Background:
Lockdowns and quarantines during the COVID-19 pandemic influenced healthcare services' usage patterns such as emergency department (ED) attendance. During the pandemic, Israel issued three lockdowns (March-May 2020, September-October 2020, and December 2020-February 2021) to mitigate the spread of COVID-19. Little is known about the impact of these lockdowns on ED attendance for injuries in the diverse population of Northern Israel.
Methods:
We described patterns of ED attendance before, during, and after COVID-19 lockdowns. We extracted data from medical records of all northern Israeli children aged 0-17 years old who attended Ziv Medical Center (ZMC) emergency department (ED) due to injury, between 01/01/2018 and 10/02/2022. We compared the volume and characteristics of ED attendance during lockdown periods to the same time periods in the 2 years before the pandemic and 1 year after the lockdowns, using chi-square tests.
Results:
Seven thousand six hundred nineteen northern children attended ZMC ED during the time periods of the study for injuries and were analyzed. Mean attendance numbers during lockdowns decreased compared to previous years, with an increase in injuries proportion (67.8% (1502/2216) vs. 52.7% (2038/3868) p < 0.001). The proportion of 0-4-year-olds attending for injuries during the lockdown increased compared to pre-pandemic (39.68% vs. 30.7%, p < 0.0001). Minority population attendance decreased (27.47% vs. 30.71% p = 0.02). Hospitalization rates increased (13.21% vs. 10.65% p = 0.01). Post-lockdown periods saw a return to the pre-pandemic age and ethnicity distribution.
Conclusions:
Compared to previous years, the volume of injuries was lower during lockdowns for all ages, with a relative increase in the proportion of injuries among younger children attending the ED. A lower proportion of attendance from minority groups suggests different health-seeking behavior patterns during emergencies compared to the general population. Understanding these differences will help better plan for future emergencies.
