Evaluation of changes in pediatric emergency department utilization during COVID-19 pandemic: Changes during COVID-19 pandemic

An analysis of the diagnoses and costs of pediatric emergency care visits: a single center study

BACKGROUND

Children's emergency care visits are common, although the costs and reasons for visits vary. This register-based study examines the costs of pediatric emergency care and the diagnoses related to visits made to the Pediatric Emergency Unit at Tampere University Hospital (Tays), Tampere, Finland.

METHODS

This retrospective study described pediatric emergency care visits made between September 2018 and December 2019 to a single center in Tampere, Finland. The data were gathered from medical files and from cost-per-patient software and analyzed in groups by age, season, level of treatment in the ED (primary or secondary), and hospitalization, as well as by diagnosis groups.

RESULTS

During the study period, 11,454 visits were made. The total costs were over €3,380,000 ($2,837,758), with a median cost per visit was €260 ($217.90). Higher costs were associated with hospitalization and treatment in secondary care. The most common diagnoses were respiratory tract infections, counseling, other infections, GI symptoms, and other reasons.

CONCLUSION

Seriously ill children incur the highest costs per visit in pediatric emergency care. Respiratory tract infections are common reasons for emergency care visits, and the reasons why children come to emergency care in Finland are similar to those in other countries.

Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic

PURPOSE

Previous literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic.

METHODS

Institutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1-June 22 in 2018 and 2019 (pre-pandemic), (2) April 1-June 22, 2020 (peak pandemic), and (3) April 1-June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics.

RESULTS

Compared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods.

CONCLUSION

During the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future.

LEVEL OF EVIDENCE

Level III.

Pediatric unit spending in the North of Italy during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, accesses to pediatric health care services decreased, as well as the consumption of traditional drugs, while the median cost per patient at the emergency department slightly increased and the cost of pediatric COVID-19 admissions to the pediatric ward too. Overall spending of a secondary level Pediatric Unit in the last two years has not been previously reported.

METHODS

This is a retrospective study conducted by the Pediatric Unit of S. Chiara Hospital of Trento, North of Italy. We collected data on consumption and spending before and during the COVID-19 pandemic (between January 2018 and December 2022).

RESULTS

The total spending ranged from 2.141.220 to 2.483.931 euros between 2018 and 2022. COVID-19 spending accounted only for 5-8% of the overall budget, while two macro-areas of spending were identified: (i) biologic drugs for inherited metabolic diseases (IMDs), that impacted for 35.4-41.3%, and (ii) technology devices for type 1 diabetes (T1D), that accounted for 41.6-32.8% of the overall budget, in 2021 and 2022, respectively. Analysis of costs along with the different health care services revealed that: (i) the spending for COVID-19 antigen tests and personal protective equipment had a major impact on the Emergency room budget (from 54 to 68% in the two years); (ii) biological drugs accounted mainly on the Pediatric Ward (for 57%), Day Hospital (for 74%) and rare disease center budget (for 95% of the spending); (iii) the cost for T1D devices was mainly due to continuous glucose monitoring, and impacted for the 97% of the outpatient clinic budget.

CONCLUSIONS

The main impact on the budget was not due to COVID-19 pandemic related costs, but to the costs for biologic drugs and T1D devices. Therefore, cost savings could be mainly achieved through generic and biosimilars introduction and with inter-regionals calls for technology devices. We emphasize how the control of spending in pediatric hospital care has probably moved from the bedside (savings on traditional drugs as antibiotics) to the bench of national or inter-regional round tables, to obtain discounts on the costs of biologic drugs and medical devices. Here we provide for the first-time in literature, data for bench-marking between secondary level Pediatric Units before and during the COVID-19 pandemic.

Preschool children with asthma during the Covid-19 pandemic: fewer infections, less wheezing

INTRODUCTION

A few studies have already investigated preschool children with asthma during the pandemic. The purpose of this research was to investigate how preschool children with asthma were affected by the precautionary measures adopted during the pandemic.

METHODS

Preschool children with asthma aged 18-60 months evaluated in our clinic in March-May 2019, before the Covid-19 pandemic, were included in the study. The lockdown continued during March, April, and May 2020. The questionnaires and asthma symptom control tests for preschool children with asthma in 2019 and 2020 were then evaluated.

RESULTS

Sixty-three preschool children with asthma, 37 boys and 26 girls, aged 18-60 months (median 47) were included in the study. The median number of upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs), and the use of antibiotics were significantly lower in 2020 than 2019 (p<.01). The median numbers of the pediatric emergency department (PED) visits and hospitalizations were also lower in 2020 than in 2019 (p<.05). In 2019, 31 children with asthma were well controlled, 28 were partly controlled, and 4 were uncontrolled, compared to 58 well controlled, four partly controlled, and one uncontrolled in 2020 (p<.01).

CONCLUSIONS

Preschool children with asthma have been positively affected in terms of PED admission, hospitalization, and asthma symptom control in association with the Covid-19 pandemic and the resulting lockdown measures. This study revealed that wheezing decreased significantly in the absence of respiratory infection in preschool children with asthma. Namely, fewer infections meant less wheezing.

Evaluation of Acute Ataxia in the Pediatric Emergency Department: Etiologies and Red Flags

BACKGROUND

We aimed to evaluate patients with acute ataxia and to determine the warning clinical factors in the early prediction of neurological emergencies.

METHOD

Patients with a history of balance and gait coordination disorder and clinically diagnosed as acute ataxia in pediatric emergency department were included in the study. As a result of final diagnosis, the characteristics of patients with and without clinically urgent neurological pathology (CUNP) were compared. CUNP was defined as any nervous system disorder requiring early diagnosis and prompt medical or surgical treatment and/or intensive care unit admission to prevent disabling or life-threatening evolution.

RESULTS

Eighty-eight patients with a median age of 5 years were included in the study (37 [42%] patients with CUNP and 51 [58%] without CUNP). In the CUNP group, the median age of patients and symptom duration were significantly higher (P < 0.001 and P = 0.011, respectively). The most common etiologies were acute post/parainfectious cerebellar ataxias (n = 40 [45.4%]), acute cerebellitis (n = 9 [10.2%]), and Guillain-Barré syndrome (n = 8 [9%]). Hyporeflexia/areflexia and dysmetria were associated with a higher risk of CUNP. Headache, loss of consciousness, and visual dysfunction were the findings appearing exclusively in patients with CUNP.

CONCLUSIONS

The most common etiologies in acute ataxia are benign and transient, whereas life-threatening conditions may occur rarely and may require urgent intervention. Older age; prolonged symptom duration; focal neurological deficits such as hemiparesis, hyporeflexia, and visual impairment; and nonspecific findings such as loss of consciousness and headache are the most striking "red flags" of a potential neurological emergency and should alert clinicians to CUNP.

The Effect of the Covid-19 pandemic on emergency service home service calls due to home accidents in children aged 0-6 in Sakarya, Türkiye?

Background and Aim

The contribution of global pandemics to the emergence of home accidents is unknown. The study aims to retrospectively examine the effect of the Covid-19 Pandemic on Emergency Service Home Service Calls Due to Home Accidents in Children aged 0-6.

Methods

Data are reported in two sections. The descriptive part is a retrospective analysis of patients admitted to Sakarya Training and Research Hospital Pediatric Emergency and Adult Emergency Unit between March 16, 2019 and January 31, 2020 (non-COVID-19era) and March 16, 2020 and January 31, 2021 (COVID-19era). The second part of the study, the comparative part, presents mean data for 2019-2020 (non-COVID-19era) and 2020-2021 (COVID-19era) from the same center and the same period. These data will then be compared.

Results

A total of 9,110 pediatric patients applied to our center during the study period, of which 7,905 patients were in the non-Covid- 19era period and 1,205 patients were in the Covid-19 era. While the rate of hospital admissions decreased by 85% in the Covid-19era compared to the non Covid-19era, when the periods are evaluated within themselves; the forensic report retention rate in the Covid- 19era increased by 180% and the rate of hospitalization increased by 75%, The rate of drug overdose increased by 280% and chemical substance use increased by 325% compared to the non-Covid-19era. However The Covid-19 era, the fall rate decreased by 31% and the burn rate decreased by 17% compared to the non-Covid-19 era.

Conclusions

During the national lockdown period, our pediatric emergency department experienced significantly reduced volumes of children. Despite the decrease in hospital admission rate during the COVID-19 pandemic, there was still a very high increase in poisoning from home accidents. This study can provide a basis for further research on alternative strategies to address the problem of home accidents during the COVID-19 pandemic.