Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore

Abstract

Background Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore. Methods We performed a retrospective review of ED attendances and hospital admissions among children < 18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs). Results We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline (p < 0.001), attributed largely to a drop in respiratory (% change − 87.9, 95% CI − 89.3 to − 86.3, p < 0.001) and gastrointestinal infections (% change − 72.4, 95%CI − 75.9 to − 68.4, p < 0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change − 40.0, 95%CI − 44.3 to − 35.3, p < 0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p < 0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change − 73.9, 95%CI − 75.9 to − 71.7, p < 0.001). Conclusions We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.

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].…”

Using ICD-10 Diagnostic Codes to Identify ‘Missing’ Paediatric Patients During Nationwide COVID-19 Lockdown in Oxfordshire, UK

“…Such reductions in infectious diseases, their sequelae, and personal injuries were reported in ED settings across the UK, Germany, USA, Italy, South Africa, and Singapore. [5,7,9,12,13]. We also saw signi cant reductions in non-speci c asthma and wheezing, both are predominantly triggered by infection in children, [18,19] and were categorised as sequelae of infectious diseases.…”

“…Signi cant reductions in infective diseases and personal injuries during international lockdown-like measures are recently reported. [7][8][9][10][11][12][13] Our data suggests 80% of 'missing' diagnoses were infective disease or sequelae of infective illness, likely as a result of adherence to pandemic/lockdown infection control measures. Such reductions in infectious diseases, their sequelae, and personal injuries were reported in ED settings across the UK, Germany, USA, Italy, South Africa, and Singapore.…”

“…Internationally, varying levels of lockdown restriction has led to reductions in paediatric emergency department (ED) attendances of around 50% (24.9-88%). [2][3][4][5][6][7][8][9][10][11][12][13][14] Many authors expressed concern about children who may be 'lost' to secondary services during lockdowns, particularly those with concerning or signi cant disease. [4,5,10,[14][15][16] Although children are deemed to be relatively unaffected by primary SARS-CoV-2 infection, [17] pandemic measures/messaging are altering patterns of paediatric disease presentation.…”

Twenty-one Days of Solitude

“…Chong et al highlighted a significant decrease in infection-related presentations in pediatric patients, likely attributed to the lockdown, and showed that the relative proportion of trauma-related attendances increased, in their study. 8 In another study on the pediatric population, Kuitunen et al, found results strongly suggesting social distancing and other lockdown strategies as effective in slowing down the spread of common respiratory viral diseases and decreasing the need for hospitalization among children. 9 Sheridan et al also concluded from their study that the COVID-19 pandemic significantly reduced the number of acute traumatic pediatric admissions and procedures performed in our level I trauma center, likely because of a reduction in school days.…”