1
|
Samman K, Le CK, Burstein B, Rehimini S, Grenier A, Bertrand-Bureau C, Mallet M, Simonyan D, Berthelot S. Parents' perspective on pediatric emergency department visits for low-acuity conditions before and during the COVID-19 pandemic: a cross-sectional bicentric study. CAN J EMERG MED 2024; 26:31-39. [PMID: 38032525 DOI: 10.1007/s43678-023-00609-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES The primary objective of this study was to describe and compare the motivation of parents/guardians to bring children with low-acuity conditions to a tertiary-care pediatric emergency department (ED) versus a clinic before and after the pandemic. The secondary objectives were to describe and compare the demographic and clinical characteristics of the population studied and the impact of the pandemic on their access to primary care services. METHODS This is a cross-sectional study based on a survey administered to parents/guardians of patients presenting with low-acuity conditions at one of two EDs. RESULTS The respondents numbered 659. Children were brought to a pediatric ED generally because of the perceived urgency of the condition, the presumed resource availability in the pediatric ED and the unavailability of the primary care physician. However, most respondents (n = 438, 66.5%) indicated preference for a clinic. More respondents before than during the pandemic reported they had been unable to find a doctor outside the ED (48.6% before COVID vs 26.8% during COVID, p < 0.001) but patients during the pandemic were less likely to seek care in a primary care practice or walk-in clinic (30.0% during COVID vs 48.6% before COVID, p < 0.001). In addition, the number of respondents presenting with symptoms of infection decreased by more than half after the pandemic began while the proportion of musculoskeletal and psychiatric complaints doubled. CONCLUSION Although the pandemic has altered the landscape of presenting complaints and pediatric healthcare-seeking behaviors, most respondents indicated they would prefer to receive care in a clinic. This finding contradicts the view that most pediatric ED visits for low-acuity conditions are by choice rather than perceived necessity. Prioritizing improved access to primary care resources would better address the preferences and expectations of parents/guardians.
Collapse
Affiliation(s)
- Karol Samman
- Department of Pediatrics, Centre Hospitalier Régional de Lanaudière, St-Charles-Borromée, QC, Canada
| | - Cathie-Kim Le
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montréal, QC, Canada
| | | | - Anthony Grenier
- Department of Family Medicine, GMF Nouvelle-Beauce, Sainte-Marie, QC, Canada
| | | | - Myriam Mallet
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Simon Berthelot
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, QC, Canada.
- Centre de recherche du CHU de Québec-Université Laval, Axe Santé des populations et pratiques optimales en santé,, Québec, QC, Canada.
| |
Collapse
|
2
|
Panteli D, Mauer N, Tille F, Nimptsch U. How did the COVID-19 pandemic affect inpatient care for children in Germany? An exploratory analysis based on national hospital discharge data. BMC Health Serv Res 2023; 23:938. [PMID: 37653471 PMCID: PMC10472716 DOI: 10.1186/s12913-023-09929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The delivery of health services around the world faced considerable disruptions during the COVID-19 pandemic. While this has been discussed for a number of conditions in the adult population, related patterns have been studied less for children. In light of the detrimental effects of the pandemic, particularly for children and young people under the age of 18, it is pivotal to explore this issue further. METHODS Based on complete national hospital discharge data available via the German National Institute for the Reimbursement of Hospitals (InEK) data browser, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020, 2021 and 2022. We analyse the development of monthly admissions between January 2019 and December 2022 for three tracers of variable time-sensitivity: acute lymphoblastic leukaemia (ALL), appendicitis/appendectomy and tonsillectomy/adenoidectomy. RESULTS Compared to 2019, total admissions were approximately 20% lower in 2020 and 2021, and 13% lower in 2022. The composition of the most frequent principal diagnoses remained similar across years, although changes in rank were observed. Decreases were observed in 2020 for respiratory and gastrointestinal infections, with cases increasing again in 2021. The number of ALL admissions showed an upward trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions decreased by about 9% in 2020 and a further 8% in 2021 and 4% in 2022, while tonsillectomies/adenoidectomies decreased by more than 40% in 2020 and a further 32% in 2021 before increasing in 2022; for these tracers, monthly changes are in line with pandemic waves. CONCLUSIONS Hospital care for critical and urgent conditions among patients under the age of 18 was largely upheld in Germany during the COVID-19 pandemic, potentially at the expense of elective treatments. There is an alignment between observed variations in hospitalisations and pandemic mitigation measures, possibly also reflecting changes in demand. This study highlights the need for comprehensive, intersectoral data that would be necessary to better understand changing demand, unmet need/foregone care and shifts from inpatient to outpatient care, as well as their link to patient outcomes and health care efficiency.
Collapse
Affiliation(s)
- Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany.
- European Observatory on Health Systems and Policies, Place Victor Horta 40/30, Brussels, 1060, Belgium.
| | - Nicole Mauer
- European Observatory on Health Systems and Policies, Place Victor Horta 40/30, Brussels, 1060, Belgium
| | - Florian Tille
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Cowdray House, London, WC2A 2AE, UK
| | - Ulrike Nimptsch
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany
| |
Collapse
|
3
|
McGowan EC, McGrath M, Law A, O’Shea TM, Aschner JL, Blackwell CK, Fry RC, Ganiban JM, Higgins R, Margolis A, Sathyanarayana S, Taylor G, Alshawabkeh AN, Cordero JF, Spillane NT, Hudak ML, Camargo CA, Dabelea D, Dunlop AL, Elliott AJ, Ferrara AM, Talavera-Barber M, Singh AM, Karagas MR, Karr C, O’Connor TG, Paneth N, Wright RJ, Wright RO, Cowell W, Stanford JB, Bendixsen C, Lester BM. Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm. JAMA Netw Open 2023; 6:e2310696. [PMID: 37115545 PMCID: PMC10148204 DOI: 10.1001/jamanetworkopen.2023.10696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Importance Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm. Objective To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term. Design, Setting, and Participants In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022. Exposures Premature birth (<37 weeks' gestation). Main Outcomes and Measures The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks' gestation) and differences among preterm subgroups of individuals (<28 weeks', 28-36 weeks' vs ≥37 weeks' gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion. Results Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks' gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks' gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78). Conclusions and Relevance These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19-related health care use may facilitate refinement of care models.
Collapse
Affiliation(s)
- Elisabeth C. McGowan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Monica McGrath
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew Law
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Judy L. Aschner
- Albert Einstein College of Medicine, New York, New York
- Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | - Rebecca C. Fry
- The University of North Carolina at Chapel Hill, Chapel Hill
| | - Jody M. Ganiban
- George Washington University, Washington, District of Columbia
| | - Rosemary Higgins
- Department of Global and Community Health, College of Health and Human Sciences, George Mason University, Fort Myers, Florida
- Marieb College of Health and Human Services, Florida Gulf Coast University, Fort Myers
| | - Amy Margolis
- Columbia University Irving Medical Center, New York, New York
| | - Sheela Sathyanarayana
- University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
| | | | | | - José F. Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens
| | - Nicole T. Spillane
- Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Mark L. Hudak
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | | | - Maria Talavera-Barber
- Avera McKennan Hospital, Sioux Falls, South Dakota
- University Health Center, Avera Research Institute, Sioux Falls, South Dakota
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Catherine Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
| | | | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing
| | - Rosalind J. Wright
- Institute for Exposomic Research, Icahn School of Medicine Mount Sinai, New York, New York
| | - Robert O. Wright
- Institute for Exposomic Research, Icahn School of Medicine Mount Sinai, New York, New York
| | - Whitney Cowell
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | | | - Casper Bendixsen
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Barry M. Lester
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| |
Collapse
|
4
|
Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child 2023; 108:115-122. [PMID: 36162959 DOI: 10.1136/archdischild-2022-324108] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING Systematic review. DESIGN Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS Children under 18 years. INTERVENTIONS National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES Changes in paediatric emergency care utilisation. RESULTS 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER CRD42021242808.
Collapse
Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Gardiner
- School of Medicine, University of Leicester, Leicester, UK
| | - Darakhshan Razzaq
- Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Danilo Buonsenso
- Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
| | - Ruud Gerard Gerard Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| |
Collapse
|
5
|
Etoori D, Harron KL, Mc Grath-Lone L, Verfürden ML, Gilbert R, Blackburn R. Reductions in hospital care among clinically vulnerable children aged 0-4 years during the COVID-19 pandemic. Arch Dis Child 2022; 107:e31. [PMID: 35728939 PMCID: PMC9271837 DOI: 10.1136/archdischild-2021-323681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic. DESIGN Birth cohort. SETTING National Health Service hospitals in England. STUDY POPULATION All children aged <5 years with a birth recorded in hospital administrative data (January 2010-March 2021). MAIN EXPOSURE Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks' gestation) or low birth weight (<2500 g). MAIN OUTCOMES Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020-2021). RESULTS Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic. CONCLUSION One in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic.
Collapse
Affiliation(s)
- David Etoori
- Institute of Health Informatics, University College London, London, UK
| | - Katie L Harron
- Department of Population, Policy and Practice, Institute of Child Health, University College London, London, London, UK
| | | | - Maximiliane L Verfürden
- Department of Population, Policy and Practice, Institute of Child Health, University College London, London, London, UK
| | - Ruth Gilbert
- Department of Population, Policy and Practice, Institute of Child Health, University College London, London, London, UK
| | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
6
|
Cheng CW, Huang YB, Chao HY, Ng CJ, Chen SY. Impact of the COVID-19 Pandemic on Pediatric Emergency Medicine: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1112. [PMID: 36013580 PMCID: PMC9413323 DOI: 10.3390/medicina58081112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 02/05/2023]
Abstract
(1) Background and Objectives: The COVID-19 pandemic has considerably affected clinical systems, especially the emergency department (ED). A decreased number of pediatric patients and changes in disease patterns at the ED have been noted in recent research. This study investigates the real effect of the pandemic on the pediatric ED comprehensively by performing a systematic review of relevant published articles. (2) Materials and Methods: A systematic review was conducted based on a predesigned protocol. We searched PubMed and EMBASE databases for relevant articles published until 30 November 2021. Two independent reviewers extracted data by using a customized form, and any conflicts were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed. (3) Results: A total of 25 articles discussing the impact of COVID-19 on pediatric emergencies were included after full-text evaluation. Geographic distribution analysis indicated that the majority of studies from the European continent were conducted in Italy (32%, 8/25), whereas the majority of the studies from North America were conducted in the United States (24%, 6/25). The majority of the studies included a study period of less than 6 months and mostly focused on the first half of 2020. All of the articles revealed a decline in the number of pediatric patients in the ED (100%, 25/25), and most articles mentioned a decline in infectious disease cases (56%, 14/25) and trauma cases (52%, 13/25). (4) Conclusions: The COVID-19 pandemic resulted in a decline in the number of pediatric patients in the ED, especially in the low-acuity patient group. Medical behavior changes, anti-epidemic policies, increased telemedicine use, and family financial hardship were possible factors. A decline in common pediatric infectious diseases and pediatric trauma cases was noted. Researchers should focus on potential child abuse and mental health problems during the pandemic.
Collapse
Affiliation(s)
- Chien-Wei Cheng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine, Taoyuan City 333, Taiwan
| | - Yan-Bo Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Hsiao-Yun Chao
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| |
Collapse
|
7
|
Meher BK, Panda I, Mishra NR, Das L, Sahu B. The Impact of COVID-19 on Pediatric Healthcare Utilization and Disease Dynamics: An Observational Study From Western Odisha. Cureus 2022; 14:e27006. [PMID: 36000109 PMCID: PMC9390950 DOI: 10.7759/cureus.27006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Children were affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus during the first and second waves of the coronavirus disease 2019 (COVID-19 pandemic. Although the severity was less in children, the fear of contracting SARS-CoV-2 at the hospital might have led to a delayed health-seeking attitude. The objective of the study was tailored around emergency health care utilization affecting outcomes. The study was done to compare the trend concerning the utilization of pediatric healthcare and immunization services, changes in the profile of diseases, and the outcomes between the pre-COVID-19 period and the COVID-19 period in a tertiary care hospital. Methods This retrospective observational study was conducted in a tertiary care hospital in western Odisha. Data were collected retrospectively from different hospital registers (outpatient register, inpatient register, and immunization records) and analyzed between the pre-COVID-19 period (April 2019 to March 2020) and the COVID-19 period (April 2020 to March 2021) with appropriate statistical procedures. Results There was a 60%, 49.8%, 51.1%, and 25.5% reduction in outpatient attendance, indoor pediatric admissions, nutritional rehabilitation centre admissions, and newborn admissions, respectively in COVID-19 period as compared to the pre-COVID-19 period. The pediatric bed occupancy rate was reduced by 54.5%. Unfavourable outcomes (death, left against medical advice, and referral) were significantly high in hospitalized children (24% vs. 18.1%, p < 0.001). The reduction in hospitalization due to common conditions like acute respiratory tract infections, bronchiolitis and asthma, and acute gastroenteritis during COVID-19 was 76.5%, 86.2%, and 39.5%, respectively. A higher percentage of low birth weight and preterm (<34 weeks) babies were admitted to special neonatal care unit (SNCU) during the pandemic (61.8% vs. 58%, p < 0.05; 18.9% vs. 15.8%; p < 0.05 respectively). Conclusion The COVID-19 pandemic and the associated lockdown led to a significant decrease in pediatric and neonatal healthcare utilization. The impact of lower care-seeking and attendance resulting in poor patient-related outcomes (malnutrition, upsurge of vaccine-preventable diseases, disease-specific hospitalization, and mortality) post-pandemic is a real threat.
Collapse
|
8
|
Levy M, Lestrade V, Said C, Jouvet P, Kawaguchi A. Consequences of Social Distancing Measures During the COVID-19 Pandemic First Wave on the Epidemiology of Children Admitted to Pediatric Emergency Departments and Pediatric Intensive Care Units: A Systematic Review. Front Pediatr 2022; 10:874045. [PMID: 35722481 PMCID: PMC9204064 DOI: 10.3389/fped.2022.874045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and pediatric intensive care units (PICU). Methods We searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 including pre-print engines such as medRxiv, bioRxiv, Litcovid and SSRN for unpublished studies on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries, compared to the historical cohort in each studied region, country, or hospital. Results We identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. A significant decline was reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries. Conclusions SDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. However, some disease groups, such as burns and DKA, showed a tendency to increase and its severity of illness at hospital presentation. Continual effort and research into the subject should be essential for us to better understand the effects of this new phenomenon of SDMs to protect the well-being of children. Systematic Review Registration Clinicaltrials.gov, identifier: CRD42020221215.
Collapse
Affiliation(s)
- Michael Levy
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
- Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Robert-Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Victor Lestrade
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
| | - Carla Said
- School of Medicine, University of Paris Saclay, Paris, France
| | - Philippe Jouvet
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
| | - Atsushi Kawaguchi
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Pediatric Critical Care, University of Montreal, Montréal, QC, Canada
- Department of Intensive Care Medicine, Pediatric Critical Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
9
|
Hill K, McCabe C, Brenner M. Organisation of care in paediatric intensive care units during the first 18 months of the COVID-19 pandemic: a scoping review protocol. BMJ Open 2022; 12:e054398. [PMID: 35613808 PMCID: PMC9133726 DOI: 10.1136/bmjopen-2021-054398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The emergence of COVID-19 has had a significant impact on hospital services, particularly care delivered to those in intensive care units (ICUs) and paediatric ICUs (PICUs) across the world. Although much has been written about healthcare delivery and the healthcare setting since COVID-19 began, to the authors' knowledge, this is the first scoping review to investigate the organisation of care and changes implemented in PICUs during the COVID-19 pandemic. The aim is to conduct a scoping review of the literature to map out the existing studies about care delivery in PICUs during the COVID-19 pandemic and the changes made to the organisation of care in these units during the first 18 months of the pandemic. This review will also identify gaps in current knowledge in this area. METHODS AND ANALYSIS This study will be guided by the Joanna Briggs Institute's methodology for scoping reviews, using Arksey and O'Malley's six-stage scoping review framework: (1) identifying the research question; (2) identifying relevant studies; (3) selecting the studies; (4) data charting; (5) collating, summarising and reporting results; and (6) consulting with experts. A comprehensive search will be conducted using the following databases: CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE. A search strategy with predefined inclusion and exclusion criteria will be used to uncover relevant research in this area. This study will include quantitative, qualitative and mixed research methods studies published in English from 2019 to May 2021. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review. The results from this study will be disseminated through conferences and in peer-reviewed academic journals for those working in the healthcare arena.
Collapse
Affiliation(s)
- Katie Hill
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Catherine McCabe
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
10
|
Wan Mohd Yunus WMA, Kauhanen L, Sourander A, Brown JSL, Peltonen K, Mishina K, Lempinen L, Bastola K, Gilbert S, Gyllenberg D. Registered psychiatric service use, self-harm and suicides of children and young people aged 0-24 before and during the COVID-19 pandemic: a systematic review. Child Adolesc Psychiatry Ment Health 2022; 16:15. [PMID: 35216630 PMCID: PMC8874300 DOI: 10.1186/s13034-022-00452-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted on psychiatric symptoms of children and young people, but many psychiatric services have been disrupted. It is unclear how service use, self-harm and suicide has changed since the pandemic started. To gain timely information, this systematic review focused on studies based on administrative data that compared psychiatric service use, self-harm and suicide before and during the pandemic among children and young people. METHODS AND FINDING A systematic review of studies published in English from 1 January 2020 to 22 March 2021 was conducted, using the Web of Science, PubMed, Embase and PsycINFO databases. Increases or reductions in service use were calculated and compared using percentages. Of the 2,676 papers retrieved, 18 were eligible for the review and they provided data from 19 countries and regions. Most studies assessed changes during the early phase of the COVID-19 pandemic, from March to July 2020, and three assessed the changes until October 2020. Fifteen studies reported a total of 21 service use outcomes that were quantitively examined. More than three-quarters of the 21 outcomes (81%) fell by 5-80% (mean reduction = 27.9%, SD = 35%). Ten of the 20 outcomes for psychiatric emergency department (ED) services reduced by 5% to 80% (mean = 40.1%, SD = 34.9%) during the pandemic. Reductions in service use were also recorded for ED visits due to suicide ideation and self-harm, referrals to secondary mental health services, psychiatric inpatient unit admissions and patients receiving treatment for eating disorders. However, there were also some increases. Suicide rate and the number of ED visits due to suicide attempts have increased, and there was an increase in the number of treatment sessions in a service that provided telemedicine. CONCLUSION Most of the studies showed reductions in the use of psychiatric services by children and young people during the early phase of the pandemic and this highlighted potential delays or unmet needs. Suicide rate has increased during the second wave of the pandemic. Further studies are needed to assess the pattern of service use in the later phases of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Wan Mohd Azam Wan Mohd Yunus
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland ,grid.410877.d0000 0001 2296 1505Department of Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor Bahru, Johor Malaysia
| | - Laura Kauhanen
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland
| | - Andre Sourander
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - June S. L. Brown
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, England, UK
| | - Kirsi Peltonen
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - Kaisa Mishina
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - Lotta Lempinen
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - Kalpana Bastola
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.502801.e0000 0001 2314 6254Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sonja Gilbert
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - David Gyllenberg
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014, Turku, Finland. .,INVEST Research Flagship, University of Turku, Turku, Finland. .,National Institute for Health and Welfare, Helsinki, Finland. .,Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
| |
Collapse
|
11
|
Pujolar G, Oliver-Anglès A, Vargas I, Vázquez ML. Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1749. [PMID: 35162772 PMCID: PMC8834942 DOI: 10.3390/ijerph19031749] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.) for original articles published between December 2019 and September 2021. A total of 53 articles were selected and analyzed using the Aday and Andersen framework as a guide. Of these, 37 analyzed changes in levels of use of health services, 15 focused on the influencing factors and barriers to access, and 1 studied both aspects. Most focused on specific diseases and the early stages of the pandemic, based on a review of records. Analyses of the impact on primary care services' use, unmet needs or inequalities in access were scarce. A generalized reduction in the use of health services was described. The most frequent access barrier described for non-COVID-19 conditions related to the services was a lack of resources, while barriers related to the population were predisposing (fear of contagion, stigma, or anticipating barriers) and enabling characteristics (worse socioeconomic status and an increase in technological barriers). In conclusion, our results show a general reduction in services' use in the early stages of the pandemic, as well as new barriers to access and the exacerbation of existing ones. In view of these results, more studies are required on the subsequent stages of the pandemic, to shed more light on the factors that have influenced access and the pandemic's impact on equity of access.
Collapse
Affiliation(s)
- Georgina Pujolar
- Health Policy Research Unit (SEPPS), Consorci de Salut i Social de Catalunya, 08022 Barcelona, Spain; (A.O.-A.); (I.V.); (M.-L.V.)
| | | | | | | |
Collapse
|
12
|
Kim WG, Brown SD, Johnston PR, Nagler J, Jarrett DY. Emergency pediatric radiology imaging trends for non-COVID-19-related illnesses through different stages of the pandemic. Emerg Radiol 2022; 29:1-8. [PMID: 34729649 PMCID: PMC8562366 DOI: 10.1007/s10140-021-01994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To evaluate how the COVID-19 pandemic affected the imaging utilization patterns for non-COVID-19-related illness in a pediatric emergency department (ED). METHODS We retrospectively reviewed radiology reports for ultrasound, CT, MRI, and fluoroscopy studies performed at a pediatric ED in April from 2017 to 2021, excluding studies for respiratory symptoms and trauma. Radiology reports and medical records were reviewed to determine if patients had a positive radiology diagnosis, the type of diagnosis, and whether it required hospital admission. Results from during the pandemic were compared to predicted rates based on pre-pandemic years. RESULTS A total of 2198 imaging studies were included. During the COVID-19 pandemic, fewer ED imaging studies were performed compared to predicted. The decrease was greater in April 2020 (RR = 0.56, p < 0.001) than in April 2021 (RR = 0.80, p = 0.038). The odds of positive diagnosis was higher during the pandemic than before, and higher in 2020 (OR 2.53, p < 0.001) than in 2021 (OR 1.38, p = 0.008). The expected numbers of positive diagnoses and hospital admittances remained within the predicted range during the pandemic (p = 0.505-0.873). CONCLUSIONS Although imaging volumes decreased during the studied months of the pandemic, the number of positive findings was unchanged compared to prior years. No differences were demonstrated in the percentage of patients admitted to the hospital with positive imaging findings. This suggests that, at our institution, the pandemic did not lead to a substantial number of missed diagnoses or severely delay the diagnosis of non-COVID-related conditions. While still lower than expected, imaging volumes increased in April 2021 suggesting a return towards baseline patient behavior as the pandemic conditions improved.
Collapse
Affiliation(s)
- Wendy G Kim
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Joshua Nagler
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Delma Y Jarrett
- Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
13
|
Guitart C, Bobillo-Perez S, Alejandre C, Armero G, Launes C, Cambra FJ, Balaguer M, Jordan I. Bronchiolitis, epidemiological changes during the SARS-CoV-2 pandemic. BMC Infect Dis 2022; 22:84. [PMID: 35073855 PMCID: PMC8785150 DOI: 10.1186/s12879-022-07041-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/07/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Bronchiolitis is the most common viral infection of the lower respiratory tract in infants under 2 years of age. The aim of this study was to analyze and compare the seasonal bronchiolitis peaks before and during the SARS-CoV-2 pandemic. METHODS Descriptive, prospective, and observational study. Patients with severe bronchiolitis admitted to the Pediatric Intensive Care Unit (PICU) of a referral tertiary hospital between September 2010 and June 2021 were included. Demographic data were collected. Viral laboratory-confirmation was carried out. Each season was analyzed and compared. The daily average temperature was collected. RESULTS 1116 patients were recruited, 58.2% of them males. The median age was 49 days. Respiratory syncytial virus (RSV) was isolated in 782 cases (70.1%). In April 2021, the first and only case of bronchiolitis caused by SARS-CoV-2 was identified. The pre- and post-pandemic periods were compared. There were statistically significant differences regarding: age, 47 vs. 73 days (p = 0.006), PICU and hospital length of stay (p = 0.024 and p = 0.001, respectively), and etiology (p = 0.031). The peak for bronchiolitis in 2020 was non-existent before week 52. A delayed peak was seen around week 26/2021. The mean temperature during the epidemic peak was 10ºC for the years of the last decade and is 23ºC for the present season. CONCLUSION The COVID-19 pandemic outbreak has led to a clearly observable epidemiological change regarding acute bronchiolitis, which should be studied in detail. The influence of the environmental temperature does not seem to determine the viral circulation.
Collapse
Affiliation(s)
- Carmina Guitart
- Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group. Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Sara Bobillo-Perez
- Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group. Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Carme Alejandre
- Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group. Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Georgina Armero
- Department of Pediatrics, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Cristian Launes
- Department of Pediatrics, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Francisco Jose Cambra
- Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Monica Balaguer
- Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group. Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group. Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Department of Pediatrics, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP. Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010032. [PMID: 35053657 PMCID: PMC8773981 DOI: 10.3390/children9010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/11/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.
Collapse
|
15
|
Rose K, Bressan S, Honeyford K, Bognar Z, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie I, Moll HA, Roland D, Titomanlio L, Nijman R. Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study. BMJ Paediatr Open 2021; 5:10.1136/bmjpo-2021-001269. [PMID: 35413003 PMCID: PMC8688729 DOI: 10.1136/bmjpo-2021-001269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/14/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Understanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave. DESIGN This cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January-May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres. RESULTS Overall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units (7%) increased their capacity. In 12 (31%) PEDs, they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs.There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.086). CONCLUSION Overall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Katy Rose
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK .,Division of Emergency Medicine - Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Kate Honeyford
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Danilo Buonsenso
- Department of Pediatrics, Catholic University of Rome, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Liviana Da Dalt
- Division of Paediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Pediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of Pediatrics, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Henriette A Moll
- Department of Pediatrics, Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, Hopital Universitaire Robert-Debre Pole de biologie recherche et produits de sante, Paris, Île-de-France, France.,FHU I2-D2 - INSERM U1141, University of Paris, Paris, France
| | - Ruud Nijman
- Department of Paediatric Emergency Medicine, Division of Medicine, Imperial College Healthcare NHS Trust, London, UK.,Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | | | | |
Collapse
|
16
|
Agostino H, Burstein B, Moubayed D, Taddeo D, Grady R, Vyver E, Dimitropoulos G, Dominic A, Coelho JS. Trends in the Incidence of New-Onset Anorexia Nervosa and Atypical Anorexia Nervosa Among Youth During the COVID-19 Pandemic in Canada. JAMA Netw Open 2021; 4:e2137395. [PMID: 34874405 PMCID: PMC8652595 DOI: 10.1001/jamanetworkopen.2021.37395] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has had considerable mental health consequences for children and adolescents, including the exacerbation of previously diagnosed eating disorders. Whether the pandemic is a factor associated with the concomitant increase in new-onset anorexia nervosa or atypical anorexia nervosa remains unknown. OBJECTIVE To assess the incidence and severity of newly diagnosed anorexia nervosa or atypical anorexia nervosa in a national sample of youth before and during the first wave of the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study analyzed new eating disorder assessments that were conducted at 6 pediatric tertiary-care hospitals in Canada between January 1, 2015, and November 30, 2020. Patients aged 9 to 18 years with a new anorexia nervosa or atypical anorexia nervosa diagnosis at the index assessment were included. EXPOSURES COVID-19-associated public health confinement measures during the first wave of the pandemic (March 1 to November 30, 2020). MAIN OUTCOMES AND MEASURES Primary outcomes were the incidence and hospitalization rates within 7 days of de novo anorexia nervosa or atypical anorexia nervosa diagnosis. Event rate trends during the first wave were compared with trends in the 5-year prepandemic period (January 1, 2015, to February 28, 2020) using an interrupted time series with linear regression models. Demographic and clinical variables were compared using a χ2 test for categorical data and t tests for continuous data. RESULTS Overall, 1883 children and adolescents with newly diagnosed anorexia nervosa or atypical anorexia nervosa (median [IQR] age, 15.9 [13.8-16.9] years; 1713 female patients [91.0%]) were included. Prepandemic anorexia nervosa or atypical anorexia nervosa diagnoses were stable over time (mean [SD], 24.5 [1.6] cases per month; β coefficient, 0.043; P = .33). New diagnoses increased during the first wave of the pandemic to a mean (SD) of 40.6 (20.1) cases per month with a steep upward trend (β coefficient, 5.97; P < .001). Similarly, hospitalizations for newly diagnosed patients increased from a mean (SD) of 7.5 (2.8) to 20.0 (9.8) cases per month, with a significant increase in linear trend (β coefficient, -0.008 vs 3.23; P < .001). These trends were more pronounced in Canadian provinces with higher rates of COVID-19 infections. Markers of disease severity were worse among patients who were diagnosed during the first wave rather than before the pandemic, including more rapid progression (mean [SD], 7.0 [4.2] months vs 9.8 [7.4] months; P < .001), greater mean (SD) weight loss (19.2% [9.4%] vs 17.5% [9.6%]; P = .01), and more profound bradycardia (mean [SD] heart rate, 57 [15.8] beats per minute vs 63 [15.9] beats per minute; P < .001). CONCLUSIONS AND RELEVANCE This cross-sectional study found a higher number of new diagnoses of and hospitalizations for anorexia nervosa or atypical anorexia nervosa in children and adolescents during the first wave of the COVID-19 pandemic in Canada. Research is needed to better understand the drivers and prognosis for these patients and to prepare for their mental health needs in the event of future pandemics or prolonged social isolation.
Collapse
Affiliation(s)
- Holly Agostino
- Division of Adolescent Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dina Moubayed
- Section of Adolescent Medicine, Department of Pediatrics, Sainte Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Taddeo
- Section of Adolescent Medicine, Department of Pediatrics, Sainte Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Rosheen Grady
- Division of Adolescent Medicine, Department of Pediatrics, McMaster’s Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Ellie Vyver
- Section of Adolescent Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, Departments of Pediatrics and Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Anna Dominic
- Division of Adolescent Medicine, Department of Pediatrics, Janeway Children’s Hospital, Memorial University, St John’s, Newfoundland, Canada
| | - Jennifer S. Coelho
- Department of Psychiatry, University of British Columbia, and Provincial Specialized Eating Disorders Program for Children and Adolescents, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
17
|
Decreased Incidence of Pediatric Intussusception during COVID-19. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111072. [PMID: 34828785 PMCID: PMC8625463 DOI: 10.3390/children8111072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) changed the epidemiology of various diseases. The present study retrospectively investigates the epidemiologic and clinical changes in pediatric intussusception for ages ≤ 7 years before (February 2019–January 2020) and after (February 2020–January 2021) the COVID-19 outbreak in a single pediatric emergency department of a university-affiliated tertiary hospital. The incidence of communicable diseases—defined as infectious diseases with the potential for human-to-human transmission via all methods, non-communicable diseases, and intussusception were decreased following the COVID-19 outbreak (15,932 to 3880 (24.4%), 12,994 to 8050 (62.0%), and 87 to 27 (31.0%), respectively). The incidence of intussusception correlated significantly with the change in incidence of communicable diseases (Poisson log-linear regression, odds ratio = 2.15, 95% CI = 1.08–4.26, and p = 0.029). Compared with the pre-pandemic period, patients of the pandemic period showed higher proportions of pathologic leading point (PLP) and hospitalization (14.8% vs. 2.3% and 18.5% vs. 4.6%, respectively), lower base excesses (−4.8 mmol/L vs. −3.6 mmol/L), and higher lactate concentrations (1.7 mmol/L vs. 1.5 mmol/L). The incidence of pediatric intussusception decreased after the COVID-19 pandemic. This reduced incidence may be related to the reduced incidence of communicable diseases. However, the proportions of more severe diseases and PLPs were higher after the COVID-19 pandemic.
Collapse
|
18
|
Hu N, Nassar N, Shrapnel J, Perkes I, Hodgins M, O'Leary F, Trudgett C, Eapen V, Woolfenden S, Knight K, Lingam R. The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia - a time series analysis. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 19:100311. [PMID: 34746898 PMCID: PMC8564784 DOI: 10.1016/j.lanwpc.2021.100311] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/17/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023]
Abstract
Background The first wave of the COVID-19 pandemic hit New South Wales (NSW) Australia in early 2020, followed by a sharp state-wide lockdown from mid-March to mid-May. After the lockdown, there had been a low level of community transmission of COVID-19 over a year. Such pandemic experiences provide unique opportunity to understand the impact of the pandemic on paediatric health service use as countries emerge from the pandemic. Methods We examined the difference between the observed and the predicted numbers of inpatient admissions and emergency department (ED) attendances, respectively, related to chronic, acute infectious and injury conditions, for each month during the COVID-19 period (January 2020-February 2021), based on the numbers from 2016 to 2019, using records from two major paediatric hospitals in NSW. All analyses were conducted using autoregressive error models and were stratified by patient age, sex and socioeconomic status. Findings Health service use was significantly lower than predicted for admissions and/or ED attendances related to chronic conditions, acute infections, and injury during the lockdown in 2020. Change in health service use varied by chronic conditions, from the largest decrease for respiratory conditions (40-78%) to non-significant change for cancer and mental health disorders. After the lockdown, health service use for most health conditions returned to pre-COVID-19 predicted levels. However, for mental health disorders, increased health service use persisted from June 2020 up to February 2021 by 30-55%, with higher increase among girls aged 12-17 years and those from socioeconomically advantaged areas. There was persistently lower health service use for acute infections and increased health service use for injuries. Differences by socio-demographic factors were noted for mental health disorders and injuries. Interpretation The immediate return to pre-COVID-19 levels for most chronic conditions after the first lockdown in NSW highlights the healthcare needs for children affected by chronic conditions. Persistently lower health service use for acute infections is likely attributable to the decreased social contact. Sustained and targeted mental health support is essential to address the potentially increased demand for services among children during and beyond the pandemic. Funding Financial Markets Foundation for Children Chair (RL, NN), NHMRC Investigator Grant (APP1197940) (NN), NHMRC Career Development fellowship (GNT1158954) (SW)
Collapse
Affiliation(s)
- Nan Hu
- Population Child Health Research Group, School of Women's and Children's Health, UNSW Sydney, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, The University of Sydney Children's Hospital Westmead Clinical School, Australia
| | - Jane Shrapnel
- Strategy and Innovation, Sydney Children's Hospitals Network, Australia.,The University of Sydney Children's Hospital Westmead Clinical School, Australia
| | - Iain Perkes
- School of Women's and Children's Health, UNSW Sydney, Australia.,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Australia
| | - Michael Hodgins
- Population Child Health Research Group, School of Women's and Children's Health, UNSW Sydney, Australia
| | - Fenton O'Leary
- The University of Sydney Children's Hospital Westmead Clinical School, Australia.,Emergency Department, The Children's Hospital at Westmead, Australia
| | - Carla Trudgett
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney, School of Psychiatry, UNSW Sydney
| | - Sue Woolfenden
- Population Child Health Research Group, School of Women's and Children's Health, UNSW Sydney, Australia
| | - Katherine Knight
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, UNSW Sydney, Australia
| |
Collapse
|
19
|
Benoit J, Hartling L, Chan M, Scott S. Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan. J Med Internet Res 2021; 23:e29441. [PMID: 34665144 PMCID: PMC8564653 DOI: 10.2196/29441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/19/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Providing parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices. Objective The aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved. Methods We conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores. Results Overall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy. Conclusions There is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design.
Collapse
Affiliation(s)
- James Benoit
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michelle Chan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
20
|
Laing S, Johnston S. Estimated impact of COVID-19 on preventive care service delivery: an observational cohort study. BMC Health Serv Res 2021; 21:1107. [PMID: 34656114 PMCID: PMC8520349 DOI: 10.1186/s12913-021-07131-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 has caused significant healthcare service disruptions. Surgical backlogs have been estimated but not for other healthcare services. This study aims to estimate the backlog of preventive care services caused by COVID-19. METHODS This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were crudely estimated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada. RESULTS The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (- 0.3% to - 14.7%; 95% CI), colorectal cancer decreased by 8.1% (- 0.3% to - 15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (- 0.2% to - 8.7%; 95% CI). Crude estimates imply 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI) may be overdue in Ontario. Nationally the deficits may be tripled these numbers. Re-opening measures have not reversed these trends. INTERPRETATION COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.
Collapse
Affiliation(s)
- Scott Laing
- University of Ottawa Department of Family Medicine, Telfer School of Management, Ottawa, Canada
| | - Sharon Johnston
- University of Ottawa Department of Family Medicine, Institut du Savoir Montfort, Bruyère Research Institute, Ottawa, Canada
| |
Collapse
|
21
|
Saunders N, Guttmann A, Brownell M, Cohen E, Fu L, Guan J, Sarkar J, Mahar A, Gandhi S, Fiksenbaum L, Katz A, Eze N, Stukel TA. Pediatric primary care in Ontario and Manitoba after the onset of the COVID-19 pandemic: a population-based study. CMAJ Open 2021; 9:E1149-E1158. [PMID: 34906990 PMCID: PMC8687490 DOI: 10.9778/cmajo.20210161] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There were large disruptions to health care services after the onset of the COVID-19 pandemic. We sought to describe the extent to which pandemic-related changes in service delivery and access affected use of primary care for children overall and by equity strata in the 9 months after pandemic onset in Manitoba and Ontario. METHODS We performed a population-based study of children aged 17 years or less with provincial health insurance in Ontario or Manitoba before and during the COVID-19 pandemic (Jan. 1, 2017-Nov. 28, 2020). We calculated the weekly rates of in-person and virtual primary care well-child and sick visits, overall and by age group, neighbourhood material deprivation level, rurality and immigrant status, and assessed changes in visit rates after COVID-19 restrictions were imposed compared to expected baseline rates calculated for the 3 years before pandemic onset. RESULTS Among almost 3 million children in Ontario and more than 300 000 children in Manitoba, primary care visit rates declined to 0.80 (95% confidence interval [CI] 0.77-0.82) of expected in Ontario and 0.82 (95% CI 0.79-0.84) of expected in Manitoba in the 9 months after the onset of the pandemic. Virtual visits accounted for 53% and 29% of visits in Ontario and Manitoba, respectively. The largest monthly decreases in visits occurred in April 2020. Although visit rates increased slowly after April 2020, they had not returned to prerestriction levels by November 2020 in either province. Children aged more than 1 year to 12 years experienced the greatest decrease in visits, especially for well-child care. Compared to prepandemic levels, visit rates were lowest among rural Manitobans, urban Ontarians and Ontarians in low-income neighbourhoods. INTERPRETATION During the study period, the pandemic contributed to rapid, immediate and inequitable decreases in primary care use, with some recovery and a substantial shift to virtual care. Postpandemic planning must consider the need for catch-up visits, and the long-term impacts warrant further study.
Collapse
Affiliation(s)
- Natasha Saunders
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man.
| | - Astrid Guttmann
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Marni Brownell
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Eyal Cohen
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Longdi Fu
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Jun Guan
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Joykrishna Sarkar
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Alyson Mahar
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Sima Gandhi
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Lisa Fiksenbaum
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Alan Katz
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Nkiruka Eze
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| | - Therese A Stukel
- The Hospital for Sick Children (Saunders, Guttmann, Cohen); Department of Paediatrics (Saunders, Guttmann, Cohen), University of Toronto; ICES Central (Saunders, Guttmann, Cohen, Fu, Guan, Gandhi, Stukel); Child Health Evaluative Sciences (Saunders, Guttmann, Cohen, Fiksenbaum), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Guttmann, Cohen, Stukel), Temerty Faculty of Medicine (Saunders, Guttmann, Cohen) and Edwin S.H. Leong Centre for Healthy Children (Saunders, Guttmann, Cohen), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar, Katz), University of Manitoba; Manitoba Centre for Health Policy (Brownell, Sarkar, Mahar, Katz, Eze); Children's Hospital Research Institute of Manitoba (Brownell); Department of Family Medicine (Katz), University of Manitoba, Winnipeg, Man
| |
Collapse
|
22
|
Davis AL, Sunderji A, Marneni SR, Seiler M, Hall JE, Cotanda CP, Klein EJ, Brown JC, Gelernter R, Griffiths MA, Hoeffe J, Gualco G, Mater A, Manzano S, Thompson GC, Ahmed S, Ali S, Goldman RD. Caregiver-reported delay in presentation to pediatric emergency departments for fear of contracting COVID-19: a multi-national cross-sectional study. CAN J EMERG MED 2021; 23:778-786. [PMID: 34402036 PMCID: PMC8366744 DOI: 10.1007/s43678-021-00174-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
Objective To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. Methods This was a pre-planned secondary analysis of a cross-sectional survey study of caregivers accompanying their children aged 0–19 years to 16 pediatric EDs in 5 countries from May to June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concern about the child or caregiver having COVID-19 at the time of ED visit. Results Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child’s symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27–2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14–2.79), younger age of caregiver (OR 0.965, 95% CI 0.943–0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04–1.12) were independently associated with a COVID-19-related delayed presentation in multivariable regression analysis. Conclusions Almost one in five caregivers reported delaying ED presentation for their ill or injured child specifically due to fear of contracting COVID-19 while in hospital, with mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work more likely to report delaying ED presentation. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-021-00174-z.
Collapse
Affiliation(s)
- Adrienne L Davis
- Pediatric Emergency Medicine, Hospital for Sick Children and Department of Pediatrics, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Alia Sunderji
- Pediatric Emergency Medicine, Hospital for Sick Children and Department of Pediatrics, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Shashidhar R Marneni
- Division of Pediatric Emergency Medicine, Children's Medical Center of Dallas, UT Southwestern Medical Center, Dallas, TX, USA
| | - Michelle Seiler
- Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jeanine E Hall
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | | | - Eileen J Klein
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Julie C Brown
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Renana Gelernter
- Pediatric Emergency Medicine Unit, Shamir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Griffiths
- Division of Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, GA, USA
| | - Julia Hoeffe
- Pediatric Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Gianluca Gualco
- Pediatric Emergency Department, Pediatric Institute of Italian Part of Switzerland, Ticino, Switzerland
| | - Ahmed Mater
- Pediatric Emergency Medicine, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Graham C Thompson
- Pediatrics and Emergency Medicine, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Sara Ahmed
- Department of Emergency Medicine, Mary Bridge Children's Hospital, Tacoma, WA, USA
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | |
Collapse
|
23
|
Kruizinga MD, Peeters D, van Veen M, van Houten M, Wieringa J, Noordzij JG, Bekhof J, Tramper-Stranders G, Vet NJ, Driessen GJA. The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature. Eur J Pediatr 2021; 180:2271-2279. [PMID: 33723971 PMCID: PMC7959585 DOI: 10.1007/s00431-021-04015-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023]
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.
Collapse
Affiliation(s)
- Matthijs D. Kruizinga
- Juliana Children’s Hospital (Haga Teaching hospital), Els Borst-Eilersplein 275, 2545 AA The Hague, the Netherlands
- Centre for Human Drug Research, Leiden, the Netherlands
| | - Daphne Peeters
- Juliana Children’s Hospital (Haga Teaching hospital), Els Borst-Eilersplein 275, 2545 AA The Hague, the Netherlands
| | - Mirjam van Veen
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, the Netherlands
| | - Marlies van Houten
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp/Haarlem, the Netherlands
| | - Jantien Wieringa
- Department of Pediatrics, Haaglanden Medical Centre, The Hague, the Netherlands
| | - Jeroen G. Noordzij
- Department of Pediatrics, Reinier de Graaf Ziekenhuis, Delft, the Netherlands
| | - Jolita Bekhof
- Department of Pediatrics, Isala, Zwolle, the Netherlands
| | | | - Nienke J. Vet
- Department of Pediatrics, St Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Gertjan J. A. Driessen
- Juliana Children’s Hospital (Haga Teaching hospital), Els Borst-Eilersplein 275, 2545 AA The Hague, the Netherlands
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
24
|
Burstein B, Anderson G, Yannopoulos A. Prevalence of Serious Bacterial Infections Among Febrile Infants 90 Days or Younger in a Canadian Urban Pediatric Emergency Department During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2116919. [PMID: 34255052 PMCID: PMC8278260 DOI: 10.1001/jamanetworkopen.2021.16919] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This cross-sectional study compares the prevalence of severe bacterial infections in febrile neonates and infants before vs during the COVID-19 pandemic in Montreal, Quebec, Canada.
Collapse
Affiliation(s)
- Brett Burstein
- Montreal Children’s Hospital, Division of Pediatric Emergency Medicine, McGill University, Montreal, Quebec, Canada
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Gregory Anderson
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | |
Collapse
|
25
|
Seiler M, Staubli G, Hoeffe J, Gualco G, Manzano S, Goldman RD. A tale of two parts of Switzerland: regional differences in the impact of the COVID-19 pandemic on parents. BMC Public Health 2021; 21:1275. [PMID: 34193102 PMCID: PMC8242280 DOI: 10.1186/s12889-021-11315-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We aimed to document the impact of the coronavirus disease 2019 (COVID-19) pandemic on regions within a European country. METHODS Parents arriving at two pediatric emergency departments (EDs) in North of Switzerland and two in South of Switzerland completed an online survey during the first peak of the pandemic (April-June 2020). They were asked to rate their concern about their children or themselves having COVID-19. RESULTS A total of 662 respondents completed the survey. Parents in the South were significantly more exposed to someone tested positive for COVID-19 than in the North (13.9 and 4.7%, respectively; P < 0.001). Parents in the South were much more concerned than in the North that they (mean 4.61 and 3.32, respectively; P < 0.001) or their child (mean 4.79 and 3.17, respectively; P < 0.001) had COVID-19. Parents reported their children wore facemasks significantly more often in the South than in the North (71.5 and 23.5%, respectively; P < 0.001). CONCLUSION The COVID-19 pandemic resulted in significant regional differences among families arriving at EDs in Switzerland. Public health agencies should consider regional strategies, rather than country-wide guidelines, in future pandemics and for vaccination against COVID-19 for children.
Collapse
Affiliation(s)
- Michelle Seiler
- Pediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Georg Staubli
- Pediatric Emergency Department, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Julia Hoeffe
- Pediatric Emergency Department, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Gianluca Gualco
- Pediatric Emergency Department, Pediatric Institute of Italian part of Switzerland, Bellinzona, Switzerland
| | - Sergio Manzano
- Pediatric Emergency Department, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
26
|
Lyall MJ, Lone NI. Higher clinical acuity and 7-day hospital mortality in non-COVID-19 acute medical admissions: prospective observational study. Emerg Med J 2021; 38:366-370. [PMID: 33658271 PMCID: PMC7931206 DOI: 10.1136/emermed-2020-210030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To understand the effect of COVID-19 lockdown measures on severity of illness and mortality in non-COVID-19 acute medical admissions. DESIGN A prospective observational study. SETTING 3 large acute medical receiving units in NHS Lothian, Scotland. PARTICIPANTS Non-COVID-19 acute admissions (n=1682) were examined over the first 31 days after the implementation of the COVID-19 lockdown policy in the UK on 23 March 2019. Patients admitted over a matched interval in the previous 5 years were used as a comparator cohort (n=14 954). MAIN OUTCOME MEASURES Patient demography, biochemical markers of clinical acuity and 7-day hospital inpatient mortality. RESULTS Non-COVID-19 acute medical admissions reduced by 44.9% across all three sites in comparison with the mean of the preceding 5 years (p<0.001). Patients arriving during this period were more likely to be male, of younger age and to arrive by emergency ambulance transport. Non-COVID-19 admissions during lockdown had a greater incidence of acute kidney injury, lactic acidaemia and an increased risk of hospital death within 7 days (4.2% vs 2.5%), which persisted after adjustment for confounders (OR 1.87, 95% CI 1.43 to 2.41, p<0.001). CONCLUSIONS These data demonstrate a significant reduction in non-COVID-19 acute medical admissions during the early weeks of lockdown. Patients admitted during this period were of higher clinical acuity with a higher incidence of early inpatient mortality.
Collapse
Affiliation(s)
- Marcus J Lyall
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
| | - Nazir I Lone
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
27
|
Using ICD-10 diagnostic codes to identify 'missing' paediatric patients during nationwide COVID-19 lockdown in Oxfordshire, UK. Eur J Pediatr 2021; 180:3343-3357. [PMID: 34037838 PMCID: PMC8150620 DOI: 10.1007/s00431-021-04123-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/31/2022]
Abstract
The study aims to identify 'missing' diagnoses amongst paediatric admissions during the UK's first national lockdown, compared with the previous 5 years. A retrospective observational cohort study of all children (0-15 years) attending for urgent care across Oxfordshire, during the first UK lockdown in 2020, compared to matched dates in 2015-2019, across two paediatric hospitals providing secondary care, including one with tertiary services. Our outcome measures were changes in numbers of patients attending and inpatient diagnoses (using ICD-10 classification) during the first 2020 lockdown, compared with the previous 5 years, were used. We found that total Emergency Department (ED) attendances (n = 4030) and hospital admissions (n = 1416) during the first UK lockdown were reduced by 56.8% and 59.4%, respectively, compared to 2015-2019 (5-year means n = 7446.8 and n = 2491.6, respectively). Proportions of patients admitted from ED and length of stay were similar across 2015-2020. ICD-10 diagnoses in lockdown of 2020 (n = 2843) versus matched 2015-2019 dates (n = 19,946) demonstrated significantly greater neoplasm diagnoses (p = 0.0123). Of diagnoses 'missing' in lockdown, 80% were categorised as infectious diseases or their sequelae and 20% were non-specific pains/aches/malaise and accidental injury/poisonings.Conclusions: Pandemic public health measures significantly altered paediatric presentations. Oxfordshire hospitals had a 58% reduction in ED attendances/inpatient admissions, with 'missing' diagnoses predominantly infection-related illnesses. These are likely driven by a combination of the following: (1) public health infection control measures successfully reducing disease transmission, (2) parents/carers keeping mild/self-limiting disease at home, and (3) pandemic-related healthcare anxieties. Prospective studies are needed to ensure referral pathways identify vulnerable children, those with social concerns, and avoid delayed presentation. What is Known: • Significant reductions of paediatric ED attendances and inpatient admissions are reported globally, throughout national and regional lockdowns for COVID-19. • Previous studies (supplemental table 5) examined only ED diagnoses or specific inpatient diagnoses during lockdown periods, demonstrating reductions of infectious diseases, accidents/injuries, and safeguarding referrals. What is New: • Using ICD-10 coding, robustly controlling for five historical years and adopting a hypothesis-independent analysis, demonstrating 80% of 'missing' inpatient diagnoses during national COVID-19 lockdown were infectious diseases or its sequelae, the remainder being non-specific aches/pains/malaise and accidental injuries/poisonings. • Greater numbers of neoplasms and other specific diagnoses were detected during lockdown, including greater documentation of co-morbidities and incidental findings.
Collapse
|
28
|
Zurl C, Eber E, Siegl A, Loeffler S, Stelzl E, Kessler HH, Egger M, Schweintzger NA, Zenz W, Strenger V. Low Rate of SARS-CoV-2 Infections in Symptomatic Patients Attending a Pediatric Emergency Department. Front Pediatr 2021; 9:637167. [PMID: 33898359 PMCID: PMC8064389 DOI: 10.3389/fped.2021.637167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/09/2021] [Indexed: 12/14/2022] Open
Abstract
Children and adolescents seem to be at lower risk of developing clinical symptoms of COVID-19. We analyzed the rate of SARS-CoV-2 infections among 3,605 symptomatic children and adolescents at 4,402 outpatient visits presenting to a pediatric emergency department. In a total of 1,105 (32.6%) episodes, the patients fulfilled clinical case definitions for SARS-CoV-2 infection and were tested by nucleic acid testing. A SARS-CoV-2 infection was diagnosed in 10/1,100 episodes (0.3% of analyzed episodes, 0.91% of validly tested patients). Symptoms at presentation did not differ between patients with and without SARS-CoV-2 infection, apart from the frequency of measured temperature ≥37.5°C at presentation. Three percent of analyzed children reported disturbances of olfactory or gustatory senses, but none of them was infected with SARS-CoV-2. The rate of SARS-CoV-2 infections among symptomatic children and adolescents was low and SARS-CoV-2 infections could not reliably be differentiated from other infections without nucleic acid testing.
Collapse
Affiliation(s)
- Christoph Zurl
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria.,Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Ernst Eber
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Anna Siegl
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Sabine Loeffler
- Emergency Department, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Evelyn Stelzl
- Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Graz, Austria
| | - Harald H Kessler
- Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Graz, Austria
| | - Markus Egger
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Nina A Schweintzger
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Werner Zenz
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Volker Strenger
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| |
Collapse
|