Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network

Abstract

Background The COVID‐19 pandemic affected the volume and epidemiology of pediatric emergency department (ED) visits. We aimed to determine the rate of associated complications for 16 high‐risk conditions in a Michigan statewide network of academic and community EDs during the pandemic. Methods We conducted a cross‐sectional study of pediatric ED visits among a network of 5 Michigan health systems during the pre‐pandemic (March 1, 2019–March 10, 2020) and pandemic (March 11, 2020–March 31, 2021) periods. Data were collected from the medical record and included patient demographics, ED visit characteristics, procedure codes, and final International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. Selection of codes for 16 high‐risk conditions and diagnostic complications were identified using previously described methods. Characteristics of ED visits were compared before versus during the pandemic using χ 2 and Fisher's exact tests. We used multilevel logistic regression to analyze covariates and potential confounders for being diagnosed with a high‐risk condition or a complication of a high‐risk condition. Results A total of 417,038 pediatric ED visits were analyzed. The proportion of patients presenting with 10 of 16 high‐risk conditions (including appendicitis, sepsis, and stroke) was higher in the pandemic period compared with pre‐pandemic ( P < 0.01). Despite this, there was no significant increase in the frequency of complications for any of the 16 high‐risk conditions during the pandemic. The adjusted odds of being diagnosed with appendicitis (pre‐pandemic 0.23% vs pandemic 0.52%; odds ratio [OR], 1.19 [95% confidence interval, CI, 1.00–1.41]), diabetic ketoacidosis (pre‐pandemic 0.16% vs pandemic 0.52%; OR, 2.40 [95% CI, 2.07–2.78]), intussusception (pre‐pandemic 0.05% vs pandemic 0.07%; OR, 1.64 [95% CI, 1.22–2.21)], and testicular torsion (pre‐pandemic 0.10% vs pandemic 0.14%; OR, 1.64 [95% CI, 1.18–2.28]) was higher during the pandemic. Conclusions Despite a higher proportion of ED visits attributed to high‐risk conditions, there was no increase in complications, suggesting minimal impact of the pandemic on outcomes of pediatric ED visits.

Federated data health networks hold potential for accelerating emergency research

“…The COVID pandemic further underscored the ongoing need for nimble, multi‐centered, multi‐disciplinary, collaborative approaches to understand the rapidly evolving epidemiology of the virus, and assess the impact, efficacy, and effectiveness of various operational and therapeutic interventions. Our recent work on COVID's impact on diagnostic delays across 14 EDs in Michigan 3 and a survey on the impact of COVID on provider burnout and innovation across 74 EDs in 28 countries 4 has revealed that EDs are willing to commit site resources to contribute data for research in emergency care. To overcome the shortcomings of centralized data approaches, a distributed/de‐centralized approach called federated data health networks (FDHN) has been successfully deployed in COVID research; this has opened the potential for similar approaches to emergency care network‐based research 5,6 …”