Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital

Abstract

Background Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period. Methods The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. Results The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. Conclusions In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn’t demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.

Evaluation of changes in pediatric emergency department utilization during COVID-19 pandemic

“…The median waiting time in the PED was found to have decreased by threefold and twofold for 50% and 75% of patients, respectively. Significant decreases in the number of emergency room admissions have also been reported in other studies [ 12 , 13 ]. Reducing waiting time is often an important goal in PED reorganization and a significant metric that is monitored by health authorities [14] .…”

Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis

“…Gender and age were almost equally distributed between the 2 years. ED visits consistently dropped in March (− 52%) and April (− 52%) 2020 during the first pandemic wave as already described in other Italian settings [6][7][8]. During summer, the reduction of SARS-CoV-2 contagion and COVID-19 related-hospitalization rates were associated with a gradual increase in ED presentations.…”

“…During the COVID-19 pandemic, a consistent decrease in ED visits has been recorded worldwide. Italy has been the first western country to register a reduction in individuals seeking medical attention in EDs, although studies describing this phenomenon are mostly limited to the first pandemic wave [6][7][8].…”

The Disappearance of Respiratory Viruses in Children during the COVID-19 Pandemic

“…Matera et al demonstrated that during the lockdown period, Emergency Room admissions decreased by 81% compared to 2019, and this reduction was significantly higher for air communicable diseases [5]. Raucci et al also demonstrated a strong reduction in visits in Emergency Department for Respiratory Diseases [6].…”