The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

Abstract

The coronavirus disease 2019 pandemic has enormous impact on society and healthcare. Countries imposed lockdowns, which were followed by a reduction in care utilization. The aims of this study were to quantify the effects of lockdown on pediatric care in the Netherlands, to elucidate the cause of the observed reduction in pediatric emergency department (ED) visits and hospital admissions, and to summarize the literature regarding the effects of lockdown on pediatric care worldwide. ED visits and hospital admission data of 8 general hospitals in the Netherlands between January 2016 and June 2020 were summarized per diagnosis group (communicable infections, noncommunicable infections, (probable) infection-related, and noninfectious). The effects of lockdown were quantified with a linear mixed effects model. A literature review regarding the effect of lockdowns on pediatric clinical care was performed. In total, 126,198 ED visits and 47,648 admissions were registered in the study period. The estimated reduction in general pediatric care was 59% and 56% for ED visits and admissions, respectively. The largest reduction was observed for communicable infections (ED visits: 76%; admissions: 77%), whereas the reduction in noninfectious diagnoses was smaller (ED visits 36%; admissions: 37%). Similar reductions were reported worldwide, with decreases of 30–89% for ED visits and 19–73% for admissions.Conclusion: Pediatric ED utilization and hospitalization during lockdown were decreased in the Netherlands and other countries, which can largely be attributed to a decrease in communicable infectious diseases. Care utilization for other conditions was decreased as well, which may indicate that care avoidance during a pandemic is significant. What is Known:• The COVID-19 pandemic had enormous impact on society.• Countries imposed lockdowns to curb transmission rates, which were followed by a reduction in care utilization worldwide. What is New:• The Dutch lockdown caused a significant decrease in pediatric ED utilization and hospitalization, especially in ED visits and hospital admissions because of infections that were not caused by SARS-CoV-2.• Care utilization for noninfectious diagnoses was decreased as well, which may indicate that pediatric care avoidance during a pandemic is significant.

Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas

“…Our study is consistent with prior literature reporting a decrease in healthcare utilization during the pandemic, particularly hospitalizations and emergency department visits. [ 8 , 9 , 10 , 11 ]. However, our study adds to the sparse literature, by evaluating 79 clinics across four large, academic institutions in the Southeastern US, indicating decreased utilization of pediatric primary care [ 12 , 19 ].…”

“…However, our study adds to the sparse literature, by evaluating 79 clinics across four large, academic institutions in the Southeastern US, indicating decreased utilization of pediatric primary care [ 12 , 19 ]. Reasons for decreased primary care visits include patients’ fear of contracting the SARS-CoV-2 infection [ 11 , 18 ], practices deferring elective visits [ 21 ], governmental stay at home orders [ 9 ], and decreased infection-related visits [ 22 ]. These missed primary care appointments have the potential to lead to long-lasting detrimental health effects in children.…”

“…The pandemic has resulted in a significant decrease in pediatric emergency department visits and hospitalizations. [ 8 , 9 , 10 , 11 ]. There has also been a decrease in pediatric primary care visits due to concerns about children becoming infected with SARS-CoV-2, or in order to comply with stay-at-home orders [ 12 ].…”

Integrated Sustainable Childhood Pneumonia and Infectious Disease Reduction in Nigeria (INSPIRING) Through Whole System Strengthening in Jigawa, Nigeria: Study Protocol For a Cluster Randomised Controlled Trial

“…A 30% intervention effect on mortality is reasonable, given previous PLA trials and clinical interventions to improve pneumonia case management. [6,37] However, we risk being under-powered if under-ve mortality has declined more rapidly than we presumed, or we are unable to reliably record death events.…”

A tale of two parts of Switzerland: regional differences in the impact of the COVID-19 pandemic on parents

“…The COVID-19 pandemic resulted in a decrease in pediatric emergency medicine attendances from 30% up to 76%, mainly for communicable infections [ 8 , 9 ].…”