Where have all the children gone? Decreases in paediatric emergency department attendances at the start of the COVID-19 pandemic of 2020

Isba, Rachel; Edge, Rhiannon; Jenner, Rachel; Broughton, Emily; Francis, Natalie; Butler, Jim

doi:10.1136/archdischild-2020-319385

Cited by 189 publications

(234 citation statements)

References 3 publications

(4 reference statements)

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“…Pandemic-related service closures, warnings and public health measures have led to substantially reduced use of health care services by children, young people and families. In the United Kingdom, 4 Ireland 5 and Italy, 6 routinely collected admissions data show decreases of up to 75% in pediatric emergency department attendances and admissions during lockdown compared with the same period in previous years. The Hospital for Sick Children in Toronto reported a reduction in pediatric emergency department visits by 30% in March and 62% in April 2020 compared with 2019 (Dr. Karim Jessa, The Hospital for Sick Children, Toronto, Ont: personal communication, 2020).…”

Section: What Are the Potential Indirect Physical Health Effects Of Tmentioning

confidence: 98%

Addressing the indirect effects of COVID-19 on the health of children and young people

Chanchlani

Buchanan

Gill

2020

CMAJ

134

139

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Section: What Are the Potential Indirect Physical Health Effects Of Tmentioning

confidence: 98%

Addressing the indirect effects of COVID-19 on the health of children and young people

Chanchlani

Buchanan

Gill

2020

CMAJ

134

139

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“…During the Covid-19 pandemic, there has been a clinical epidemiological change about the onset of many diseases: in some countries, a decrease of common paediatric diseases has been reported [2,13], such as asthma and acute respiratory tract infection [14]. Since schools and sport centres closed, the number of acute infections and traumas among children were lower than usual [15].…”

Section: Discussionmentioning

confidence: 99%

“…Since then, according to literature [2,3], we have witnessed a worldwide massive drop in emergency department (ED) paediatric admissions, partially due to both the higher prevalence of this disease in older age groups [4] and mildasymptomatic clinical course in children and adolescents [5].…”

Section: Introductionmentioning

confidence: 99%

Is Covid-19 lockdown related to an increase of accesses for seizures in the emergency department? An observational analysis of a paediatric cohort in the Southern Italy

et al. 2020

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Background The World Health Organization (WHO) declared a global pandemic of Covid-19 on 11 March 2020. The lockdown caused a lifestyle changes: an increase in the use of mobile media devices (MMDs), sleep and psychiatric disorders, incorrect habits regarding food and physical activities. We investigate prevalence of admission for seizures at our emergency department (ED), during Italian lockdown, comparing with that of the same period of the previous year (2019), and the relationship with some lifestyle changes. Methods In this observational study, patients (4–14 years) with seizures that accessed at our ED, during Italian lockdown, were eligible. Non-epileptic events and febrile seizures were excluded. We describe two groups: patients with new-onset seizures and not. Moreover, a questionnaire concerning use of MMDs and sleep habits was administered. Results Fifty-seven patients were included; median age 8.03 years. Considering only paediatric medical emergencies, the prevalence of accesses for seizures was 2.6% (CI 95% 0.020–0.034), while the incidence was 0.94% (CI 95% 0.006–0.0149). There was a statistically significant difference with prevalence of previous years, χ2 102.21 (p = 0.0001). We also reported a difference in daily screen time (DST) (p = 0.001) and total sleep time (TST) (p = 0.045), in all population, between period pre- and during lockdown. A negative correlation between DST and seizures latency (Spearman’s ρ -0.426, p = 0.038) was found. In the two groups, the results were partially overlapping. Conclusions During lockdown period, we assisted to an increase of accesses for seizures. It is conceivable that a sleep time change and/or higher MMD use could act as triggers for seizures.

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“…After a reduction in the number of presentations to emergency departments during the lockdown periods across Europe ( 33 ), the raised awareness of PIMS-TS in the media might lead to an increase of presentations of children with fever and other infectious symptoms to acute care facilities. Public health bodies should communicate clearly with the general public about the warning signs of PIMS-TS and about when to seek care as to prevent delayed presentations ( 34 , 35 ).…”

Section: Statementmentioning

confidence: 99%

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

et al. 2020

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A rise in cases with a new hyperinflammatory disease in children has been reported in Europe and in the Unites States of America, named the Pediatric Inflammatory Multisystem Syndrome—temporally associated with SARS-CoV-2 (PIMS-TS). There appears to be a wide spectrum of signs and symptoms with varying degrees of severity, including a toxic shock like presentation with hypovolaemia and shock, and a Kawasaki-like presentation with involvement of the coronary arteries. Most of these children have evidence of a previous infection with SARS-CoV-2, or a history of significant exposure, but not all. Limited data exist on the incidence of PIMS-TS, but it remains a rare condition. Early recognition and escalation of care is important to prevent the development of serious sequelae, such as coronary artery aneurysms. Clinicians assessing febrile children in primary and secondary care should include PIMS-TS in their differential diagnoses. In children fulfilling the case definition, additional investigations should be undertaken to look for evidence of inflammation and multiorgan involvement. Suspected cases should be discussed with experts in pediatric infectious diseases at an early stage, and advice should be sought from critical care in more severe cases early. There is limited consensus on treatment; but most children have been treated with immunoglobulins or steroids, and with early consideration of biologicals such anti-TNF and anti-IL1 agents. Treatment should ideally be within the context of controlled treatment trials. Clinicians are encouraged to document and share their cases using research registries.

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Where have all the children gone? Decreases in paediatric emergency department attendances at the start of the COVID-19 pandemic of 2020

Cited by 189 publications

References 3 publications

Addressing the indirect effects of COVID-19 on the health of children and young people

Addressing the indirect effects of COVID-19 on the health of children and young people

Is Covid-19 lockdown related to an increase of accesses for seizures in the emergency department? An observational analysis of a paediatric cohort in the Southern Italy

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

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