Reluctance to seek pediatric care during the COVID-19 pandemic and the risks of delayed diagnosis

Ciacchini, Benedetta; Tonioli, Francesco; Marciano, Cinzia; Faticato, Maria Grazia; Borali, Elena; Prato, Alessio Pini; Felici, Enrico

doi:10.1186/s13052-020-00849-w

Cited by 91 publications

(111 citation statements)

References 7 publications

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“…In addition, parental fear of contracting SARS-CoV-2 infection in hospital settings represented a significant determinant of ED accesses reduction. Late diagnoses, sometimes with consequent death due to delayed access to hospital care, have been reported in March 2020 in some [15,19] but not all [20] Italian secondary and tertiary care hospitals. In our study, we described 2 cases of delayed ED access to hospital setting (1 in April and 1 in May), as a consequence of not justified parental fear.…”

Section: Discussionmentioning

confidence: 99%

“…Monthly comparison of pediatric ED visits performed from January to May 2020 confirmed a significant reduction in daily consultations after February, with a considerable percentage of days with ≤ 3 visits/day ( Table 1). Daily pediatric ED consultations significantly varied also considering pre-and post-lockdown beginning period (pre-lockdown, 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)…”

Section: Impact Of Covid-19 Pandemic On Pediatric Ed Consultationsmentioning

confidence: 99%

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How COVID-19 Pandemic Changed Children and Adolescents Use of the Emergency Department: the Experience of a Secondary Care Pediatric Unit in Central Italy

Vierucci¹,

Bacci

Mucaria

et al. 2020

SN Compr. Clin. Med.

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Italy was the first European country hit by SARS-CoV-2 infection, particularly northern regions. After the beginning of national lockdown (March 9th, 2020), we observed a significant decrease in pediatric emergency department consultations (daily pediatric visits; pre-lockdown, 16 (11-22); lockdown, 3 (1-3); phase 2, 3 (3-5), p < 0.0001). On the other hand, the percentage of children discharged right after pediatric visit significantly decreased from 80% in January to 50% in April. After March 9th, we registered a change in the diagnoses of emergency department visits, with an increase in the percentage of non-infectious acute conditions and a decrease in infectious diseases, with two cases of a noteworthy delayed access to hospital care. We performed a retrospective analysis of consultations requested to our pediatric unit for children and adolescents referred to the general Emergency Department of San Luca Hospital of Lucca (Tuscany, Central Italy) from January 1st to May 31st, 2020. We split data in two different time periods according to consultations performed before (January 1st-March 8th) and after the beginning of lockdown (March 9th-May 31st). Analyzing the number of children hospitalized from January to May 2020 in comparison with the same period in 2019, a decreased hospitalization became evident after March (March − 74.6%, April − 71.6%, May − 58.6%). Nasopharyngeal What is Known: Italy was the first European country hit by SARS-CoV-2 infection. Published preliminary Italian data confirmed a general favorable clinical course of COVID-19 in childhood. What is New: Even if COVID-19 pandemic more seriously affected Northern Italy, the admission of children and adolescents to pediatric emergency services significantly changed also in Central Italy with reduced demand and increased appropriateness.

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Section: Discussionmentioning

confidence: 99%

Section: Impact Of Covid-19 Pandemic On Pediatric Ed Consultationsmentioning

confidence: 99%

How COVID-19 Pandemic Changed Children and Adolescents Use of the Emergency Department: the Experience of a Secondary Care Pediatric Unit in Central Italy

Vierucci¹,

Bacci

Mucaria

et al. 2020

SN Compr. Clin. Med.

View full text Add to dashboard Cite

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“…Data show that lockdown, combined with intense fear of COVID-19 contagion, led to a dramatic decrease in patients seeking medical care for other emergent issues [76][77][78]. In addition, ambulatory and screening services were postponed, including routine immunizations given to infants and children [79].…”

Section: Indirect Consequences On Child Healthmentioning

confidence: 99%

COVID-19 in the Pediatric Population—Review and Current Evidence

Rabinowicz

Leshem

Pessach

2020

Curr Infect Dis Rep

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Purpose of Review Coronavirus disease 2019 (COVID-19) pandemic has major health and economic impacts. We review disease characteristics in children. Recent Findings Children comprise 1-2% of the diagnosed cases, and typically suffer mild disease. The median age of infected children is 3.3-11 years, and male/female ratio is 1.15-1.55. Common symptoms in children include upper respiratory symptoms (26-54%), cough (44-54%), fever (32-65%), and gastrointestinal (15-30%) symptoms. Substantial proportion (4-23%) are asymptomatic. Death rates are up to 0.7%. Risk factors associated with severe disease are neonatal age group, male gender, lower respiratory tract disease, and pre-existing medical conditions. Vertical transmission was reported. Multisystem inflammatory syndrome (MIS), characterized by fever, multisystem organ involvement, and laboratory markers of inflammation, causes critical illness in > 50% of cases and is increasingly reported from endemic countries. Indirect effects of the coronavirus epidemic include higher rates of psychiatric morbidities, education loss, unhealthy lifestyle changes, and increased child neglect. Vaccines are in clinical trials and immunogenicity has not yet been shown in children. Summary Overall, COVID-19 has lower incidence and causes milder disease in children compared with adult patients. MIS is a rare severe complication more common in children. More data on the efficacy and safety of antivirals in children are needed.

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“…Although some studies report on the consequences of delayed presentations to emergency departments, insight in the nature and severity of delayed presentation to regular paediatric care is missing. 2 3 Our objective was to explore the collateral harm in Dutch children and adolescents during the COVID-19 pandemic from the experience of paediatricians.…”

mentioning

confidence: 99%

Delayed presentation to regular Dutch paediatric care in COVID-19 times: a national survey

Jansen

Illy

2020

bmjpo

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We explored the collateral harm in Dutch children and adolescents during the COVID-19 pandemic from experience of paediatricians via an open question distributed via the website of the Dutch Paediatric Society. From the end of March till the first week of July, we received 51 reports of collateral harm involving mostly very young children with mainly acute physical problems but also social problems. In older children, several cases of diabetic ketoacidosis were reported. Our results show that delaying care can lead to seriously ill children, life-threatening situations and that in some cases it can even lead to death. If we want to avoid such a delay at a possible second peak of Corona, general care providers and paediatricians have to join forces and find new ways of working. Systematic data collection of collateral harm in children is needed to be able to intervene adequately.

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Reluctance to seek pediatric care during the COVID-19 pandemic and the risks of delayed diagnosis

Cited by 91 publications

References 7 publications

How COVID-19 Pandemic Changed Children and Adolescents Use of the Emergency Department: the Experience of a Secondary Care Pediatric Unit in Central Italy

How COVID-19 Pandemic Changed Children and Adolescents Use of the Emergency Department: the Experience of a Secondary Care Pediatric Unit in Central Italy

COVID-19 in the Pediatric Population—Review and Current Evidence

Delayed presentation to regular Dutch paediatric care in COVID-19 times: a national survey

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