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Examining Pediatric Emergency Utilization Trends Before and After the COVID-19 Pandemic: An Eight-Year Cohort Study
Hae Jeong Lee1, Yechan Kyung1, Dong Wan Kang1
1Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea.
Insights
Pediatric emergency department visits dropped 55.5% post-COVID-19, with fewer infants and young children but more adolescents. Illness patterns shifted, with more non-specific symptoms and trauma visits.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly altered healthcare utilization patterns globally.
- Understanding shifts in pediatric emergency department (ED) use is crucial for resource allocation and public health planning.
- Pre-existing trends in pediatric ED visits may have been exacerbated or modified by pandemic-related changes.
Purpose of the Study:
- To investigate changes in pediatric ED utilization before and after the COVID-19 pandemic.
- To analyze age-specific trends, triage severity, diagnostic categories, and clinical presentations in pediatric ED visits.
- To inform age-specific strategies for emergency planning and pediatric public health policy.
Main Methods:
- Retrospective analysis of 71,560 pediatric ED visits (Samsung Changwon Hospital, 2016-2023).
- Categorization into pre-COVID-19 (2016-2019) and post-COVID-19 (2020-2023) periods.
- Analysis of age groups, Korean Triage and Acuity Scale (KTAS) scores, diagnoses (ICD-10), and outcomes.
Main Results:
- A 55.5% decrease in overall pediatric ED visits post-pandemic.
- Shift in age distribution: decreased visits for infants/young children, increased visits for adolescents.
- Increased lower-acuity visits (KTAS 4), higher discharge rates, reduced admissions, and a rise in non-specific symptoms and trauma diagnoses.
Conclusions:
- The COVID-19 pandemic has profoundly impacted pediatric ED utilization, altering visit volume, illness patterns, and severity by age.
- Significant changes observed in diagnostic categories, with a decrease in respiratory/infectious diseases and an increase in non-specific symptoms and trauma.
- Findings necessitate age-specific emergency planning and public health policies to address pandemic-induced behavioral and healthcare access changes.
Abstract:
Purpose: This study investigates trends in pediatric emergency department (ED) utilization before and after the COVID-19 pandemic, with a focus on age-specific patterns, triage severity, diagnostic categories, and clinical presentations. Methods: Data were collected for 71,560 individuals (40,428 males and 31,132 females aged 0-18 years) who visited the ED at Samsung Changwon Hospital between 1 January 2016 and 31 December 2023. Patients were categorized into pre-COVID-19 (2016-2019) and post-COVID-19 (2020-2023) periods. Age, Korean Triage and Acuity Scale (KTAS) scores, visit outcomes, diagnostic codes (ICD-10), and vital signs were analyzed. Age-specific analyses were performed in four groups: <12 months, 1-6 years, 7-12 years, and 13-18 years. Results: Since the COVID-19 pandemic, pediatric ED visits have decreased by 55.5%. The proportion of visits by infants (<12 months) and young children (1-6 years) decreased, and adolescent visits increased. Post-pandemic, there was a significant increase in lower-acuity visits (KTAS 4) and discharge rates, alongside a reduction in admissions. Visits for respiratory and infectious diseases (ICD-10 J and A & B codes) decreased markedly, and visits for non-specific symptoms (R codes) and trauma (S & T codes) increased. The mean body weight of young children increased significantly after the COVID-19 period. Conclusions: The COVID-19 pandemic has had a profound and lasting effect on pediatric emergency department utilization, with changes in the number of visits, illness patterns, and severity by age group. These findings highlight the need for age-specific strategies in emergency planning and pediatric public health policy, particularly in managing the indirect effects of pandemic-induced changes in behavior and access to healthcare.
