46 Clinical Characteristics of COVID-19 Patients in the Emergency Department Predict Hospitalization and Critical Illness: A Retrospective Cohort Study

Abstract

Study Objective: SARS-CoV-2 was declared a pandemic March 11, 2020 by the WHO. Adult health care systems faced tremendous challenges in volume and acuity; however, morbidity and mortality among children is low and pediatric emergency departments (EDs) have been spared the same challenges. Treatment of SARS-CoV-2 patients and efforts to curb disease transmission affected health care delivery in the United States causing negative effects on the delivery of routine primary care, the closures of schools, the implementation of shelter-in-place orders, and the cancellation of typical activities for children. The impact of these factors and the COVID-19 epidemic on pediatric EDs has yet to be fully understood. Our study contributes by demonstrating the COVID-19 epidemic's impact on our tertiary care pediatric ED and level 1 trauma center.Methods: This retrospective time series study was conducted in a southern state with data coming from three sources: 1. State Office of EMS 2. ED visits and admissions 3. Hospital trauma database. The hospital is a free-standing children's hospital with an annual ED census around 75,000 prior to 2020. The hospital is the only state certified pediatric level I trauma center. Strict criteria exist for triggering trauma team activation. Four years of data were analyzed for number of patients seen, number and percent of patients admitted to a critical care unit, number and percent patients who met trauma activation criteria, and number of EMS transfers. This study was deemed exempt by the institutional review board since data were de-identified and aggregate. Data were managed using Excel TM .Results: Overall volume decreased 34% from 74,513 (2019) to 48,924 (2020) in contrast to trends of volume from 2017 through 2019, which had shown a steady increase by an additional 1,100 patients per year. Annual admission rate rose from 13.4-13.9% in 2017-2019 to 18.6% in 2020. The institution saw a linear increase in combined admission rates to the intensive care and intermediate care units from a high of 23.7% (2019) to 25.4% (2020) with a corresponding decrease in admission rates to acute care floors. Rate of admission to inpatient psychiatry unit increased from an average yearly rate of 7.2-7.7% in 2017-2019 to 9.3% in 2020. The number of patients transferred via EMS to our institution from outside facilities increased 8.8% from 1,868 in 2019 to 2,034 in 2020. Trauma alert activations increased from 0.65% of total patient volume in 2019 to 1.2% in 2020 with a noticeable increase in firearm related injuries from 44 in 2019 to 66 in 2020.Conclusion: While total volumes of patients seen in our tertiary pediatric ED showed a significant decrease during the COVID-19 pandemic there were significant increases in acuity as evidenced by admission rate, admission location, and number of interfacility transfers to our pediatric emergency department. There were also significant increases in psychiatric admissions and trauma alerts.