Pediatric Emergency Department Responses to COVID-19: Transitioning From Surge Preparation to Regional Support

Hartford, Emily A.; Keilman, Ashley; Yoshida, Hiromi; Migita, Russell; Enriquez, Brianna; Liu, Deborah R.

doi:10.1017/dmp.2020.197

Cited by 11 publications

(21 citation statements)

References 4 publications

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“…It is important to predict any changes in patterns of patient ED visits and establish guidelines, to actively respond to the pandemic situation. 30 At the current rate, EDs will not be crowded with non-urgent pediatric patients who have simple infections, as it did before the COVID-19 pandemic. When or if the COVID-19 pandemic ends and the students resume school after a long break, we hope that the children seek prompt medical care for the timely identification of diseases during their treatment windows.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Emergency Department Utilization and Coronavirus Disease in Daegu, Korea

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Pediatric Emergency Department Utilization and Coronavirus Disease in Daegu, Korea

et al. 2021

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“…4 A growing body of evidence suggests reduced utilization stems from public fears of contracting COVID-19 in healthcare settings. [2][3][4][5][6] Delays in timely care for emergent conditions have led to increased illness presentation severity and increased disease complications. [5][6][7][8] Diabetic ketoacidosis (DKA) is a condition sensitive to timely diagnosis, with increased severity noted in those with new-onset diabetes, initial misdiagnosis, and limited access to care.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on the Severity of Diabetic Ketoacidosis Presentations in a Tertiary Pediatric Emergency Department

Jafari

Koves

Rutman

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: More severe presentations of diabetic ketoacidosis (DKA) have been reported during the coronavirus disease 2019 (COVID-19) pandemic, possibly due to avoidance of healthcare settings or reduced access to care. To date, no studies have utilized statistical process control to relate temporal COVID-19 events with DKA severity. Our objectives were (1) to determine whether the severity of pediatric DKA presentations changed during COVID-19 and (2) to temporally relate changes in severity with regional pandemic events. Methods: This study was a retrospective chart review of 175 patients younger than 18 years with DKA presenting to a pediatric emergency department in the United States between 5/1/2019 and 8/15/2020. As part of our ongoing clinical standard work in ED management of DKA, DKA severity measures, including presenting pH, the proportion of PICU admissions, and admission length of stay, were analyzed using statistical process control. Results: During COVID-19, we found special cause variation with a downward shift in the mean pH on DKA presentation from 7.2 to 7.1 for all patients. The proportion of DKA patients requiring PICU admission increased from 34.2% to 54.6%. Changes temporally corresponded to the statewide bans on large events (3/11/2020), school closures (3/13/2020), and a reduction in our institution’s emergency department volumes. Admission length of stay was unchanged. Conclusions: Pediatric DKA presentations were more severe from March to June 2020, correlating with regional COVID-19 events. Future quality improvement interventions to reduce delayed presentations during COVID-19 surges or other natural disasters should target accessibility of care and public education regarding the importance of timely care for symptoms.

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“…Given that the first case of SARS-CoV-2 infection in the US was reported on January 21, 2020 just outside Seattle, Washington, Seattle Children's Hospital activated a hospital incident command structure on January 22 in response to the first US case occurring regionally. The pediatric ED operations committee began pandemic preparation on February 12, 2020 (Hartford et al, 2020). We speculate that implementation of an early response to the pandemic that rapidly incorporated new ED and hospital based processes that included extra PPE for staff may be a factor that contributed to a lower seroprevalence among HCWs in Seattle compared to Atlanta.…”

Section: Discussionmentioning

confidence: 98%

Prevalence of SARS-CoV-2 antibodies in pediatric healthcare workers

Morris¹,

Sullivan²,

Mantus³

et al. 2021

International Journal of Infectious Diseases

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To determine SARS-CoV-2-antibody prevalence in pediatric healthcare workers (pHCWs). Design: Baseline prevalence of anti-SARS-CoV-2-IgG was assessed in a prospective cohort study from a large pediatric healthcare facility. Prior SARS-CoV-2 testing history, potential risk factors and anxiety level about COVID-19 were determined. Prevalence difference between emergency department (ED)-based and non-ED-pHCWs was modeled controlling for those covariates. Chi-square test-fortrend was used to examine prevalence by month of enrollment. Results: Most of 642 pHCWs enrolled were 31-40years, female and had no comorbidities. Half had children in their home, 49% had traveled, 42% reported an illness since January, 31% had a known COVID-19 exposure, and 8% had SARS-CoV-2 PCR testing. High COVID-19 pandemic anxiety was reported by 71%. Anti-SARS-CoV-2-IgG prevalence was 4.1%; 8.4% among ED versus 2.0% among non-ED pHCWs (p < 0.001). ED-work location and known COVID-19 exposure were independent risk factors. 31% of antibody-positive pHCWs reported no symptoms. Prevalence significantly (p < 0.001) increased from 3.0% in April-June to 12.7% in July-August. Conclusions: Anti-SARS-CoV-2-IgG prevalence was low in pHCWs but increased rapidly over time. Both working in the ED and exposure to a COVID-19-positive contact were associated with antibodyseropositivity. Ongoing universal PPE utilization is essential. These data may guide vaccination policies to protect front-line workers.

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Pediatric Emergency Department Responses to COVID-19: Transitioning From Surge Preparation to Regional Support

Cited by 11 publications

References 4 publications

Pediatric Emergency Department Utilization and Coronavirus Disease in Daegu, Korea

Pediatric Emergency Department Utilization and Coronavirus Disease in Daegu, Korea

Impact of the COVID-19 Pandemic on the Severity of Diabetic Ketoacidosis Presentations in a Tertiary Pediatric Emergency Department

Prevalence of SARS-CoV-2 antibodies in pediatric healthcare workers

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