Delayed presentation of children to the emergency department during the first wave of COVID‐19 pandemic in Italy: Area‐based cohort study

Rusconi, Franca; Fabrizio, Valeria Di; Puglia, Monia; Sica, Michela; Santis, Rita De; Masi, Stefano; Gagliardi, Luigi

doi:10.1111/apa.16019

Cited by 12 publications

(13 citation statements)

References 23 publications

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“…The Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetology demonstrated that, during the lockdown, there were 23% fewer new diabetes cases compared to the same period in 2019 and that children presenting with DKA had more severe DKA (pH < 7.1) in 2020 than in 2019 (p = 0.03), although no diagnoses were missed overall [15]. Similar findings have been reported by other authors for other serious diseases [16].…”

Section: Discussionsupporting

confidence: 70%

Changing Admission Patterns in Pediatric Emergency Departments during the COVID-19 Pandemic in Italy Were Due to Reductions in Inappropriate Accesses

et al. 2021

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During the initial phase of the national lockdown, we found that there were sharp decreases in admissions to two pediatric emergency departments (EDs) in northern Italy (Cremona and Novara). Here we present a detailed analysis of these admission patterns and types of admissions over a longer timeframe. ED admissions data were anonymously extracted from the departmental management software. Admissions data from 2019 and 2020 were analyzed and compared separately for each ED and combined. There was a 73.2% decrease in total admissions compared with the same period in 2019. With respect to admission diagnoses, there was a significant (p < 0.001) drop in infectious (−51%), respiratory (−25.5%), and nervous systems diseases (−50%) and injuries and poisoning (−17%) but not endocrine, metabolic, neoplastic, circulatory, or musculoskeletal diseases. White codes (patients with minor injuries for whom ED medical care is not required) significantly decreased by 56.3% (p < 0.001). Even if the COVID-19 pandemic represented an enormous healthcare burden in Italy, especially during the first months of the pandemic (late February to May), the workload of pediatric EDs was significantly reduced, especially for unnecessary accesses (white codes).

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Section: Discussionsupporting

confidence: 70%

Changing Admission Patterns in Pediatric Emergency Departments during the COVID-19 Pandemic in Italy Were Due to Reductions in Inappropriate Accesses

et al. 2021

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“…Several studies reported reduced pediatric health care contacts, emergency department (ED) presentations, admissions, and pediatric intensive care admissions in Italy, the UK, Scotland, and Australia during local lockdowns [2,[10][11][12][13], mainly driven by substantial reductions in respiratory diseases. Trauma-specific investigations from several countries (UK, Ireland, Canada, New Zealand) showed decreases up to 60% for pediatric trauma presentations to EDs [4,[14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Impact of the First COVID Lockdown on Accident- and Injury-Related Pediatric Intensive Care Admissions in Germany—A Multicenter Study

et al. 2022

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Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.

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“…As far as the utilization of EMS services by patients' subgroups is concerned, it is interesting to note that paediatric ED admissions and hospitalization were those most severely affected. This dramatic decline of EMS utilization in this age group is probably due to a combination of factors such as the reduction of trauma and injuries related to closure of schools, leisure and sport activities, and the reduction of recrudescence of diseases related to air pollution and of other infectious diseases [38][39][40][41]. Furthermore, it should be pointed out that inappropriate utilization of EMS is commonly reported for paediatric patients [38,42], however delayed presentation for acute illnesses-probably linked to the reduced access to primary care-were reported during the first wave of the pandemic [38,40].…”

Section: Plos Onementioning

confidence: 99%

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services during the first pandemic wave: A system-wide study of Tuscany Region, Italy

et al. 2022

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Background Utilization of Emergency Medical Services (EMS) declined during COVID-19 pandemic, but most of the studies analyzed components of the EMS system individually. The study aimed to evaluate the indirect impact of COVID-19 pandemic on the utilization of all the components of the EMS system of Tuscany Region (Italy) during the first pandemic wave. Methods Administrative data from the health care system of Tuscany were used. Changes in utilization for out-of-hospital emergency calls and emergency vehicle dispatched, emergency department (ED) visits, and patients being admitted from the ED to an inpatient hospital bed (hospitalizations from ED) during the first pandemic wave were analyzed in relation with corresponding periods of the previous two years. Percentage changes and 95%CI were calculated with Poisson models. Standardized Ratios were calculated to evaluate changes in in-hospital mortality and hospitalizations requiring ICU. Results Significant declines were observed in the utilization of all the EMS considered starting from the week in which the first case of COVID-19 was diagnosed in Italy till the end of the first pandemic wave. During the epidemic peak, the maximum decreases were observed: -33% for the emergency calls, -45% for the dispatch of emergency vehicles, -71% for ED admissions. Furthermore, a decline of 37% for hospitalizations from ED was recorded. Significant decreases in ED admissions for life threatening medical conditions were observed: acute cerebrovascular disease (-36%, 95% CI: -43, -29), acute myocardial infarction (-42%, 95% CI: -52, -31) and renal failure (-42%, 95% CI: -52, -31). No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the epidemic peak. Conclusion All the components of the EMS showed large declines in their utilization during COVID-19 pandemic; furthermore, major reductions were observed for admissions for time-dependent and life-threatening conditions. Efforts should be made to ensure access to safe and high-quality emergency care during pandemic.

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Delayed presentation of children to the emergency department during the first wave of COVID‐19 pandemic in Italy: Area‐based cohort study

Cited by 12 publications

References 23 publications

Changing Admission Patterns in Pediatric Emergency Departments during the COVID-19 Pandemic in Italy Were Due to Reductions in Inappropriate Accesses

Changing Admission Patterns in Pediatric Emergency Departments during the COVID-19 Pandemic in Italy Were Due to Reductions in Inappropriate Accesses

Impact of the First COVID Lockdown on Accident- and Injury-Related Pediatric Intensive Care Admissions in Germany—A Multicenter Study

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services during the first pandemic wave: A system-wide study of Tuscany Region, Italy

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