Impact of the COVID-19 Pandemic on Pediatric Emergency Medicine: A Systematic Review

Abstract

(1) Background and Objectives: The COVID-19 pandemic has considerably affected clinical systems, especially the emergency department (ED). A decreased number of pediatric patients and changes in disease patterns at the ED have been noted in recent research. This study investigates the real effect of the pandemic on the pediatric ED comprehensively by performing a systematic review of relevant published articles. (2) Materials and Methods: A systematic review was conducted based on a predesigned protocol. We searched PubMed and EMBASE databases for relevant articles published until 30 November 2021. Two independent reviewers extracted data by using a customized form, and any conflicts were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed. (3) Results: A total of 25 articles discussing the impact of COVID-19 on pediatric emergencies were included after full-text evaluation. Geographic distribution analysis indicated that the majority of studies from the European continent were conducted in Italy (32%, 8/25), whereas the majority of the studies from North America were conducted in the United States (24%, 6/25). The majority of the studies included a study period of less than 6 months and mostly focused on the first half of 2020. All of the articles revealed a decline in the number of pediatric patients in the ED (100%, 25/25), and most articles mentioned a decline in infectious disease cases (56%, 14/25) and trauma cases (52%, 13/25). (4) Conclusions: The COVID-19 pandemic resulted in a decline in the number of pediatric patients in the ED, especially in the low-acuity patient group. Medical behavior changes, anti-epidemic policies, increased telemedicine use, and family financial hardship were possible factors. A decline in common pediatric infectious diseases and pediatric trauma cases was noted. Researchers should focus on potential child abuse and mental health problems during the pandemic.

The effect of the COVID-19 pandemic on pediatric emergency department utilization in three regions in Switzerland

“…A US study even found that visits had not yet normalized until January 2022 [ 23 ]. The reasons for this may include parents’ fear of contracting COVID-19 in EDs [ 36 – 38 ], fewer infections due to containment measures such as wearing face masks at public gatherings [ 38 ], and longer lasting and more drastic COVID-19 measures due to a more severe course of the pandemic in the two neighboring countries.…”

“…The most common diagnoses in pediatric EDs are breathing difficulties, febrile illnesses, and gastroenterits [ 39 ], which mostly affect young children [ 40 ]. These diseases declined during and after the nationwide installation of NPIs [ 38 , 41 ]. The lower rates of communicable diseases in this age group were probably caused by fewer contacts with other children and less parent- or siblings-to-child-transmission because of hygiene and containment measures.…”

The effect of the COVID-19 pandemic on pediatric emergency department utilization in three regions in Switzerland

“…The reasons for this may include parents' fear of contracting COVID-19 in EDs (18, 19,33), fewer infections due to containment measures such as wearing face masks at public gatherings (33), and longer lasting and more drastic COVID-19 measures due to a more severe course of the pandemic in the two neighboring countries.…”

Review of pediatric emergency care and the COVID‐19 pandemic

“…At the same time, PED volumes declined sharply, leading to reduced pediatric emergency physician hours in many PEDs. 23 Additionally, at some institutions, pediatric-trained staff (physicians, nurses, respiratory therapists, etc) were given temporary change in delineation of privileges to expand scope of practice and were redeployed to care for adults as part of the disaster response, or were transitioned to providing telehealth services. 15,16,24 Non-emergency medicine trainees (medical students, residents, and fellows) who were originally assigned to work within the PED experienced restrictions on patient care provision and procedures, were reassigned to care for adults, or away from the ED altogether.…”

“…The number of critically ill patients in many hospitals exceeded the number of critical care and ED beds, prompting the need for other inpatient areas to serve as intensive care units. At the same time, PED volumes declined sharply, leading to reduced pediatric emergency physician hours in many PEDs 23 . Additionally, at some institutions, pediatric‐trained staff (physicians, nurses, respiratory therapists, etc) were given temporary change in delineation of privileges to expand scope of practice and were redeployed to care for adults as part of the disaster response, or were transitioned to providing telehealth services 15,16,24 .…”