Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study

Abstract

ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave.DesignThis cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January–May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres.ResultsOverall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units (7%) increased their capacity. In 12 (31%) PEDs, they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs.There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.086).ConclusionOverall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.

Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study

“…In addition, highest national SARS-CoV-2 infection rates are given for each of the study sites, as reported by the ECDC [ 20 ],with a threshold of 80 cases per 100,000 to indicate low (green) and high (orange) prevalence. Total changes to health system as per Rose and colleagues [ 21 ]. $ Overall reduction calculated from introduction of first national public health measure until end of study period.…”

“… To derive IRRs, the predicted counts for each individual site were used as an offset in the Poisson model to account for case-mix differences between sites. $ The number of changes made in each hospital in response to the pandemic as previously detailed by Rose and colleagues [ 21 ]. ^ Low-prevalence countries were defined as a cumulative 14-day rate of < = 80 new cases per 100,000 of the population as per the ECDC [ 20 ].…”

“…For 3 diagnosis groups, the number of attendances was too low to make sensible forecasts, namely diabetic ketoacidosis, testicular torsion, and the combined group of intussusception, volvulus, and malrotation. In addition, we determined if there were associations between the change in hospital attendances and the prevalence of SARS-CoV-2 in the country, as per the European Centre for Disease Prevention and Control (ECDC), and the number of COVID-19 measures that were introduced in each hospital in response to the pandemic as previously detailed by Rose and colleagues [ 21 ]. Rose and colleagues performed a survey study describing changes in local and regional healthcare pathways, including the diverting of patient groups to or away from the ED, and service provision.…”

Patterns of presentations of children to emergency departments across Europe and the impact of the COVID-19 pandemic: retrospective observational multinational study

“…For three diagnosis groups the number of attendances were too low to make sensible forecasts, namely diabetic keto-acidosis, testicular torsionand the combined group of intussusception, volvulusand malrotation. In addition, we determined if there were associations between the change in hospital attendances and the prevalence of SARS-CoV-2 in the country, as per the European Centre for Disease Prevention and Control (ECDC) (Fig 1, S7 Table)and the number of COVID-19 measures that were introduced in each hospital in response to the pandemic as previously detailed by Rose et al [21] Rose et al performed a survey study describing all major changes in local and regional health care pathways, including the diverting of patient groups to or away from the ED, and service provision in each of the study sites. High prevalence countries were defined as a cumulative 14-day rate of >80 new cases per 100,000 of the population.…”

“…Total changes to health system as per Rose et al. [21] $ overall reduction calculated from introduction of first national public health measure until end of study period. If multiple sites per country, overall reduction for the country was estimated using the average of the overall reductions of each individual site.…”