Forecast modeling to identify changes in pediatric emergency department utilization during the COVID-19 pandemic

Ramgopal, Sriram; Pelletier, Jonathan; Rakkar, Jaskaran; Horvat, Christopher M.

doi:10.1016/j.ajem.2021.05.047

Cited by 17 publications

(20 citation statements)

References 23 publications

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“…6 The results are also compatible with time series analyses from other developed nations. 1 , 2 However, this study is the first to report persistent reductions in infectious conditions after resumption of in-person schooling. The authors posit that these changes may be driven by behavioural changes (e.g.…”

mentioning

confidence: 73%

“…In the United States, substantial declines in other transmissible infections (including pneumonia and bronchiolitis) 1 and non-infectious phenomena (e.g., trauma), have been reported. 2 Perhaps more ominously, diagnoses for other conditions, such as hyperbilirubinemia and congenital anomalies (such as coarctation of the aorta), have also presented at lower rates than predicted during the pandemic, raising the spectre of major, unaddressed healthcare needs amongst children. These trends are being observed amidst the incompletely characterized impact of stressors such as increased isolation, more than 1.5 million caregiver deaths globally due to SARS-CoV-2, and omnipresent alarm in daily headlines.…”

mentioning

confidence: 99%

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Rising Paediatric Encounters for Mental Health Diagnoses Amidst Pandemic Mitigation Strategies in New South Wales

Horvat

Pelletier

Ramgopal

2022

The Lancet Regional Health - Western Pacific

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confidence: 73%

mentioning

confidence: 99%

Rising Paediatric Encounters for Mental Health Diagnoses Amidst Pandemic Mitigation Strategies in New South Wales

Horvat

Pelletier

Ramgopal

2022

The Lancet Regional Health - Western Pacific

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“…These findings corroborate with previous international studies. (7-12, 14-17, 21-24) The strongest increase appeared to take place during winter months, a period when public health measures, including school closures were stricter. (36) In Canada, and specifically in Québec, where access to primary healthcare services remains limited for many, even in non-pandemic times,(37) the loss of supportive school and community structures could have contributed to this increased utilization of ED services.…”

Section: Discussionmentioning

confidence: 99%

“…(5) Large fluctuations in pediatric emergency department (ED) utilization have been observed. (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) Pediatric EDs are integral to the assessment, treatment and coordination of care for children and adolescents, and often serve as a safety net for vulnerable and underserved patients. (18) Increasingly, EDs also play a pivotal role in pediatric mental health emergencies, as exemplified by the rising pre-pandemic trends in mental health-related (MHR) ED visits documented in the last decade.…”

Section: Introductionmentioning

confidence: 99%

“…Reported number and proportion of MHR ED visits have not consistently followed the pattern of overall pediatric ED visits following the pandemic onset. While both MHR and overall ED visits first decreased during 2020,(7-12, 14-17, 21-24) some studies have reported increased MHR ED utilization during 2021 and early 2022. (13, 25) During this time, overall pediatric ED utilization has remained lower than pre-COVID-19 levels.…”

Section: Introductionmentioning

confidence: 99%

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A comparative analysis of pediatric mental health-related emergency department utilization in Montréal, Canada before and during the COVID-19 pandemic

Beaudry

Drouin

Gravel

et al. 2022

Preprint

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BackgroundReports on longitudinal trends in mental health–related (MHR) emergency department (ED) utilization spanning the pre- and post-pandemic periods are lacking, along with evidence comparing healthcare services utilization by sociodemographic subgroups. The aim of this study was to evaluate COVID-19–associated changes in MHR ED utilization among youth overall and by age, sex, and socioeconomic status (SES).MethodsThis retrospective cross-sectional study analyzed MHR ED utilization before and during the COVID-19 pandemic at a large urban pediatric tertiary care hospital in Montréal, Canada. All ED visits for children (5–11 years) and adolescents (12–17 years) between April 1, 2016 and November 30, 2021 were included. The main outcome was the monthly count of MHR ED visits. Pre-pandemic and pandemic periods were compared using an interrupted time series design. The effect of seasonality (in months), age (in years), sex (male or female), and SES (low, average, high) were compared using a generalized additive model.ResultsThere were a total of 437,147 ED visits (204,215 unique patients) during the five-year study period of which 9,748 (5.8%) were MHR visits (7,686 unique patients). We observed an increase of 69% (95% CI, +53% to +85%; p = .001) in the mean monthly count of MHR ED visits during the pandemic period, which remained significant after adjusting for seasonality (44% increase, 95% CI, +38% to +51%; p = .001). The chance of presenting for a MHR ED visit increased non-linearly with age. There were increased odds of presenting for a MHR ED visit among girls between the pre-pandemic and pandemic periods (OR 1.42, 95% CI 1.29–1.56). No difference by SES group during and before the COVID-19 pandemic was found (OR 1.01, 95% CI 0.89–1.15 [low]; OR 1.09, 95% CI 0.96–1.25 [high]).ConclusionsOur study shows important increases in MHR ED utilization among youth, and especially among girls, during the first 20 months of the COVID-19 pandemic, highlighting the need for sustained, targeted and scalable mental health resources to support youth mental health during the current and future crises.

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Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample

Ramgopal

Heneghan

2023

JACEP Open

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Objective The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs. Methods We conducted a retrospective cross‐sectional study of children presenting to a statewide sample of Illinois EDs between 2016 and 2021. We classified patients as having medical complexity when using 2 definitions (≥1 pediatric Complex Chronic Condition [CCC] or complex chronic disease using the Pediatric Medical Complexity Algorithm [PMCA]) and compared their overlap and clinical outcomes. Results Of 6,550,296 pediatric ED encounters, CCC criteria and PMCA criteria were met in 217,609 (3.3%) and 175,708 (2.7%) encounters, respectively. Among patients with complexity, 100,015 (34.1%) met both criteria, with moderate agreement (κ = 0.49). Children with complexity by CCC had similar rates of presentation to a pediatric hospital (16.3% vs 14.8%), admission (28.5% vs 33.7%), ICU stay (10.0% vs 10.1%), and in‐hospital mortality (0.5% vs 0.5%) compared to children with complexity by PMCA. The most common visit diagnoses for children with CCCs were related to sickle cell disease with crisis (3.9%), abdominal pain (3.6%), and non‐specific chest pain (2.7%). The most common diagnoses by PMCA were related to depressive disorders (4.9%), sickle cell disease with crisis (4.8%), and seizures (3.2%). Conclusions and Relevance The CCC and PMCA criteria of multisystem complexity identified different populations, with moderate agreement. Careful selection of operational definitions is required for proper application and interpretation in clinical and health services research.

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Forecast modeling to identify changes in pediatric emergency department utilization during the COVID-19 pandemic

Cited by 17 publications

References 23 publications

Rising Paediatric Encounters for Mental Health Diagnoses Amidst Pandemic Mitigation Strategies in New South Wales

Rising Paediatric Encounters for Mental Health Diagnoses Amidst Pandemic Mitigation Strategies in New South Wales

A comparative analysis of pediatric mental health-related emergency department utilization in Montréal, Canada before and during the COVID-19 pandemic

Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample

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