Characterizing pediatric emergency department visits during the COVID-19 pandemic

Abstract

We determine how pediatric emergency department (ED) visits changed during the COVID-19 pandemic in a large sample of U.S. EDs. Methods: Using retrospective data from January-June 2020, compared to a similar 2019 period, we calculated weekly 2020-2019 ratios of Non-COVID-19 ED visits for adults and children (age 18 years or less) by age range. Outcomes were pediatric ED visit rates before and after the onset of pandemic, by age, disposition, and diagnosis. Results: We included data from 2,213,828 visits to 144 EDs and 4 urgent care centers in 18 U.S. states, including 7 EDs in children's hospitals. During the pandemic period, adult non-COVID-19 visits declined to 60% of 2019 volumes and then partially recovered but remained below 2019 levels through June 2020. Pediatric visits declined even more sharply, with peak declines through the week of April 15 of 74% for children age < 10 years and 67% for 14-17 year. Visits recovered by June to 72% for children age 14-17, but to only 50% of 2019 levels for children < age 10 years. Declines were seen across all ED types and locations, and across all diagnoses, with an especially sharp decline in non-COVID-19 communicable diseases. During the pandemic period, there was 22% decline in common serious pediatric conditions, including appendicitis. Conclusion: Pediatric ED visits fell more sharply than adult ED visits during the COVID-19 pandemic, and remained depressed through June 2020, especially for younger children. Declines were also seen for serious conditions, suggesting that parents may have avoided necessary care for their children.

Pediatric emergency department utilization during the COVID-19 pandemic in New York City

“…In NYC, the pandemic uniquely compounded the reduced need for medical evaluations due to milder pediatric disease [ [27] , [28] , [29] ], the perceived risk of exposure to the virus by presenting to an ED, hesitancy to utilize limited medical resources, and the comprehensive restrictions set by the “NY on PAUSE” order. In the course of our study period, there was a 56% decrease in average daily volume as compared to prior years, within the range of the published literature to date [ [13] , [14] , [15] , [16] ].…”

“…However, in line with prior coronavirus epidemics such as the 2003 Severe Acute Respiratory Syndrome (SARS) [ 6 , 7 ] and the 2014 Middle East Respiratory Syndrome (MERS) [ 8 ] epidemics, pediatric emergency departments (ED's) seemed to have been spared the same influx of patients [ [9] , [10] , [11] , [12] ]. Studies published to date in the U.S. have reported widespread reductions in pediatric volumes (59%–67%) and increases in acuity [ [13] , [14] , [15] , [16] ]. Notably though, the multicenter studies in the literature have overwhelmingly examined general ED's rather than dedicated pediatric centers which have a higher proportion of medically complex pediatric patients [ 17 ].…”

Neonatal and Pediatric Emergency Room Visits in a Tertiary Center during the COVID-19 Pandemic in Italy

“…Specifically, we found a marked increase in the proportion of injuries, burns, or wounds, suggesting that the home environment remains a frequent place for accidents among children [9,10]. Similarly, other authors observed an increased relative proportion of trauma-related attendances, likely attributed to the lockdown [11,12].…”

The effect of the COVID-19 pandemic on emergency department visits for serious cardiovascular conditions

“…[ 1 ] U.S. ED visits declined precipitously, reaching a low point in the second week of April at 58% of 2019 volume. [ [2] , [3] , [4] ] Anecdotal evidence indicates that since then, ED visits have partially recovered but remain substantially below 2019 levels. Other contributors to lower ED visits likely include less communicable disease other than COVID-19, and lower injury rates, due to social distancing, mask wearing, and school/business closures, and care shifts to other venues, including telemedicine.…”