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

Abstract

Background: The COVID-19 pandemic has had a profound impact on the utilization of healthcare systems. While a general decrease in emergency department (ED) visits was observed, there were contradictory reports regarding specific patient groups, and little information on ED utilization by children. The objectives of this study were to i) investigate the impact of the pandemic on pediatric ED utilization in different language regions of Switzerland; ii) analyze trends throughout the pandemic’s second year, and iii) address implications for future healthcare. Methods: A retrospective, longitudinal cohort study was conducted at three tertiary pediatric EDs in Switzerland, representing the main language regions, from March 1st, 2018 to February 28th, 2022. Interrupted time series modeling was employed to assess the COVID-19 related impact and compare pre-pandemic and pandemic consultations. Demographic information was collected, as well as triage categories and rates of hospitalizations to differentiate between urgent and non-urgent cases. In addition, shifts of diagnoses over time were analyzed in the largest of the three pediatric EDs. Results: A total of 304’438 ED visits were recorded, with 160’318 in Zurich, 110’735 in Geneva, and 33’385 in Ticino. At the onset of the lockdown, a drop of nearly 50% in the number of ED visits was observed, followed by a gradual recovery until the second half of 2021 when the number of ED visits reached pre-pandemic levels. This pattern primarily affected the youngest age group (0-4 years old) and was consistent across patients with non-urgent and urgent medical conditions in all three regions. However, the decline in urgent visits appeared to be more pronounced in Zurich and Geneva compared to Ticino. In contrast, hospitalization rates in Ticino did not decrease significantly during the pandemic. An apparent change in diagnoses was observed in Zurich, with a significant decrease in respiratory and gastrointestinal diseases in 2020 compared with 2019, and a significant increase in the proportion of trauma patients. Conclusions: The COVID-19 pandemic had substantial effects on number and reasons for pediatric ED visits, particularly among children up to four years of age. This effect appears to be partly due to a lower number of virus transmissions in children, but it could also be partly caused by a greater reluctance of parents to seek medical advice from pediatricians with their sick children. The pandemic`s effects on the use of the pediatric EDs exceeded the peak of the pandemic and the duration of political containment measures highlighting a multifactorial modification of pediatric ED utilization. Variations between the participating EDs in different language regions suggest that future policy decisions should take regional differences into account. New ways to counsel parents might help to better react to future challenges of the pediatric health care sector.