Impact of Viral Seasonal Outbreaks on Crowding and Health Care Quality in Pediatric Emergency Departments

Noël, Guilhem; Maghoo, A M; Piarroux, Josephine; Viudes, Gilles; Minodier, Philippe; Gentile, Stéphanie

doi:10.1097/pec.0000000000001985

Cited by 3 publications

(3 citation statements)

References 40 publications

(88 reference statements)

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“…In addition, hospitalizations for bronchiolitis increased in a shorter time in the latter SOP, peaking earlier in November with a high almost double compared to the pre-pandemic period. This distribution of hospitalization resulted in the worst burden on paediatric EDs and more pronounced hospital crowding than usual [11].…”

Section: Discussionmentioning

confidence: 99%

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

et al. 2022

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After the SARS-CoV-2 pandemic, we noticed a marked increase in high-flow nasal cannula use for bronchiolitis. This study aims to report the percentage of children treated with high-flow nasal cannula (HFNC) in various seasons. The secondary outcomes were admissions for bronchiolitis, virological results, hospital burden, and NICU/PICU need. We conducted a retrospective study in four Italian hospitals, examining the medical records of all infants (< 12 months) hospitalized for bronchiolitis in the last four winter seasons (1 September–31 March 2018–2022). In the 2021–2022 winter season, 66% of admitted children received HFNC versus 23%, 38%, and 35% in the previous 3 years. A total of 876 patients were hospitalized in the study periods. In 2021–2022, 300 infants were hospitalized for bronchiolitis, 22 in 2020–2021, 259 in 2019–2020, and 295 in 2018–2019. The percentage of patients needing intensive care varied from 28.7% to 18%, 22%, and 15% in each of the four considered periods (p < 0.05). Seventy-seven percent of children received oxygen in the 2021–2022 winter; vs 50%, 63%, and 55% (p < 0.01) in the previous 3 years. NIV/CPAP was used in 23%, 9%, 16%, and 12%, respectively. In 2021–2020, 2% of patients were intubated; 0 in 2020–2021, 3% in 2019–2020, and 1% in 2018–2019.Conclusion: This study shows a marked increase in respiratory support and intensive care admissions this last winter. While these severity indexes were all driven by medical choices, more reliable indexes such as intubation rate and length of stay did not change. Therefore, we suggest that there is a more aggressive treatment attitude rather than a more severe disease. What is Known:• COVID-19 pandemic deeply impacted bronchiolitis epidemiology, reducing hospitalizations to onetenth. In the 2021-2022 winter, bronchiolitis resurged to pre-pandemic numbers in Europe. What is New:• Bronchiolitis hospitalization rose much faster in the 2021-2022 winter period, peaking at a higher level. Respiratory supports and high-flow nasal cannula increased significantly compared to the pre-pandemic era.

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Section: Discussionmentioning

confidence: 99%

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

et al. 2022

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“…Seasonal variation in presentation to the ED has been demonstrated for a variety of chief complaints including respiratory viruses, 1–3 headache, 4 acute urticaria, 5 adolescent mental health emergencies, 6 and trauma 7 . The influence of weather and school timing has also been studied as external predictors of ED utilization 8–11 . Although a previous study identified decreased usage of the pediatric ED (PED) over the summer and Thanksgiving and Christmas holidays, 12 there remains a paucity of data evaluating the seasonal variation of PED visits.…”

mentioning

confidence: 99%

“…7 The influence of weather and school timing has also been studied as external predictors of ED utilization. [8][9][10][11] Although a previous study identified decreased usage of the pediatric ED (PED) over the summer and Thanksgiving and Christmas holidays, 12 there remains a paucity of data evaluating the seasonal variation of PED visits. Previous studies have not assessed whether a patient's home address and distance from the ED are correlated with differences in clinical characteristics and seasonal usage trends, although a recent study of children with chronic medical conditions showed an increase in low-resource ED utilization among those living within 5 miles of the hospital.…”

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confidence: 99%

Pediatric ED Utilization in a Destination City

2022

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Objectives: Seasonal variation in emergency department (ED) visits has been shown for a variety of pediatric conditions, but previous studies have not considered how geographic location may also influence when and why these patients present to the ED. Our study examined the demographic and clinical characteristics as well as the seasonal variation among 3 patient populations (locals, in-state nonlocals, and out-of-state visitors) presenting to our pediatric ED (PED), which is located in a coastal, destination city.Methods: This was a retrospective chart review of PED visits from June 2014 to June 2019 at the Medical University of South Carolina Children's Hospital, a tertiary care facility located in Charleston, SC. Pediatric ED encounters were divided into 3 groups, depending on the patient's home address: local patients residing in the 3 surrounding metro counties, in-state but nonlocal patients, and out-of-state patients. Demographic and clinical information was abstracted for each visit and compared among the 3 patient groups. Seasonal variation among PED visits was determined by recording the week of the year during which each visit occurred. Results:Local patients accounted for more than 90% of PED visits with increases in visits from October to April. In-state nonlocal patients presented at consistent rates throughout the year, whereas out-of-state ED utilization peaked significantly during the summer months, Spring Break, Thanksgiving, and Christmas. Our local patient population was majority African American; our in-state nonlocal patients roughly matched our state's racial demographics, and our out-of-state population was predominantly White. Compared with in-state nonlocal patients, our local patients were more likely to present with an infection-related complaint and be diagnosed with lower-acuity conditions such as viral infection, otitis media, upper respiratory infection, cough, fever, and gastroenteritis. In-state nonlocal patients had the highest average triage acuity, more frequently had laboratory tests and imaging ordered, and were more than 4.5 times as likely to be admitted to the hospital compared with our local patients. In-state nonlocal patients were also more likely to present with a psychiatric chief complaint compared with our local patients. Out-of-state patients had a similar overall acuity to local patients but were more likely to have imaging ordered and be diagnosed with injuries such as fractures. Conclusion:At our institution, local patients, in-state nonlocal patients, and out-of-state patients exhibited 3 distinct patterns of PED utilization. Knowledge of these trends can be used to optimize resource allocation and follow-up planning, particularly for our out-of-state patient population.

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Factors influencing recurrent emergency department visits for mild acute respiratory tract infections caused by the influenza virus

Tatlıparmak,

Alpar,

Yilmaz

2023

PeerJ

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Background Seasonal viral outbreaks, exemplified by influenza A and B viruses, lead to spikes in emergency department (ED) visits, straining healthcare facilities. Addressing ED overcrowding has become paramount due to its implications for patient care and healthcare operations. Recurrent visits among influenza patients remain an underexplored aspect, necessitating investigation into factors influencing such revisits. Methods Conducted within a tertiary care university hospital, this study adopts an observational retrospective cohort design. The study included adult patients with acute respiratory symptoms diagnosed with influenza using rapid antigen testing. The cohort was divided into single and recurrent ED visitors based on revisits within 10 days of initial discharge. A comparative analysis was performed, evaluating demographics, laboratory parameters, and clinical process data between recurrent visitors and single visitors. Results Among 218 patients, 36.2% (n = 139) experienced recurrent ED visits. Age and gender disparities were not significant. Antibiotics were prescribed for 55.5% (n = 121) and antivirals for 92.7% (n = 202) of patients, with no notable influence on recurrence. Recurrent visitors exhibited lower monocyte counts, hemoglobin levels, higher PDW and P-LCR percentages, and increased anemia prevalence (p = 0.036, p = 0.01, p = 0.004, p = 0.029, p = 0.017, respectively). C-reactive protein (CRP) levels did not significantly affect recurrence. Conclusion This study highlights the pressing concern of recurrent ED visits among mild influenza patients, magnifying the challenges of ED overcrowding. The observed notable prescription rates of antibiotics and antivirals underscore the intricate landscape of influenza management. Diminished monocyte counts, hemoglobin levels, and altered platelet parameters signify potential markers for identifying patients at risk of recurrent visits.

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Impact of Viral Seasonal Outbreaks on Crowding and Health Care Quality in Pediatric Emergency Departments

Cited by 3 publications

References 40 publications

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

Pediatric ED Utilization in a Destination City

Factors influencing recurrent emergency department visits for mild acute respiratory tract infections caused by the influenza virus

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