The impact of COVID-19 on the patterns of emergency department visits among pediatric patients

Abstract

Objectives This study aimed to investigate the patterns of pediatric patients visiting emergency departments (EDs) before and after the COVID-19 pandemic and evaluate the interactive effect between the COVID-19 outbreak and age groups. Methods We performed a cross-sectional study using the nationwide emergency patient database in Korea from January 2019 to December 2020. Pediatric patients (≤18 years) who visited all 402 nationwide EDs were included. The age- and sex-standardized incidence rates of pediatric ED visits per 1,000,000 person-days were calculated, and the incidence rate ratio (IRR) was calculated. The adjusted odds ratio (aOR) and 95% confidence interval (CI) of in-hospital mortality were calculated by a multivariable logistic regression. Results Among 2,808,756 patients, 1,835,045 (65.3%) patients visited before COVID-19, and 973,711 (34.7%) patients visited after the COVID-19 period. The standardized incidence rates of ED visits per 1,000,000 person-days were 589.3 in the before COVID-19 group and 326.9 in the after COVID-19 group (IRR (95% CI): 0.55 (0.53–0.58)). By diagnosis, the IRRs (95% CI) of mental health disorders (0.84 (0.42–1.65)) and self-harm or suicidal attempts (0.99 (0.38–2.59) were not significant, while the incidence rate of infectious disease was significantly decreased (0.48 (0.42–0.54)). The aOR (95% CI) of in-hospital mortality after COVID-19 was 1.58 (1.44–1.73) compared to that before COVID-19. Conclusions During the COVID-19 pandemic, the incidence of pediatric ED visits decreased, and these effects differed by age group. Age-specific policies are needed to ensure that children receive the care they need at the right time.

Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis

“…Self-harm was the only indication for which there were sufficient data (14 study estimates across 11 studies 10 , 15 , 19 , 20 , 35 , 43 , 46 , 49 , 53 , 57 , 60 ) to meta-analyse changes in emergency department visits by sample age. There was good evidence that rates of self-harm increased among older children (mean age 16·3 years [SD 1·0]), and modest evidence of a decrease among younger children (mean age 9·0 years [SD 1·0]) ( appendix p 18 ).…”

“…Estimates of COVID-19-related change in indices of severe mental distress—including attempted suicide, self-harm, and suicidal ideation—have varied in the literature. Some authors report decreases in severe mental distress, 10 , 11 , 12 or no clear change, 13 , 14 , 15 , 16 whereas others report increases among children and adolescents, especially adolescent girls. 17 , 18 , 19 , 20 Changes in emergency department presentations for severe mental distress have also evolved during the pandemic; initial reports suggested a decline from March to May, 2020, whereas increases were documented, especially among girls, in June to December, 2020.…”

Impact of COVID-19 pandemic on emergency department length of stay and clinical outcomes of patients with severe pneumonia: A single-center observational study

“…Our ED patient volume during the COVID-19 pandemic decreased from 52,369 to 35,561, in line with previous studies. [18,[21][22][23][24] However, during the same period, the number of patients hospitalized to the general ward for pneumonia through the ED increased from 248 to 306, and the number of patients admitted to the ICU increased from 73 to 154. We attributed this change to the avoidance of patients with fever, respiratory symptoms, or dyspnea in small and medium-sized hospitals, where securing IRs is difficult, and to the concentration of these patients in tertiary hospitals.…”

Trends in emergency department visits for suicide attempts before and during the COVID-19 pandemic in Korea: A nationwide study, 2016–2021

“…All patient-related information was automatically sent from each hospital to the NEDIS in real time, and inaccurate data were filtered out by the data processing system. The detailed design and variables of the NEDIS database have been previously described ( Kim et al, 2022 ; Lee et al, 2022a ; Min et al, 2022 ). This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for observational studies.…”