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Çalışkan OF, Trabzon G, Güllü UU, Yazarlı EG, Sarı F, İpek S, El Ç. A Comparative Analysis of Pediatric Emergency Department Admissions Before and During the COVID-19 Pandemic. Cureus 2024; 16:e58436. [PMID: 38765335 PMCID: PMC11099559 DOI: 10.7759/cureus.58436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Objectives This study aims to evaluate the outbreak's impact on emergency services, with findings obtained from patients who applied to our pediatric emergency service before and during the pandemic period. Methods In this study, the Pediatric Emergency Polyclinic of Hatay Mustafa Kemal University (MKU) Department of Pediatrics was evaluated during the COVID-19 pre-pandemic period and the COVID-19 pandemic period. Demographic features, complaints, discharge situations, diagnostic groups, and diagnoses of 16,730 non-traumatic patients one month to 18 years old were compared retrospectively. Results Comparing the pre-pandemic period and the pandemic period, it was determined that there was a statistically significant difference in the average age of patients, age groups, admission hours, triage classification, complaints, and diagnoses seen. Conclusion According to the findings obtained in the study, pediatric emergency department admissions decreased significantly during the pandemic period. As a result of the pandemic measures taken, the incidence of diseases caused by infectious agents, such as respiratory tract infections, decreased. The change in pediatric emergency service habits with the pandemic highlights the importance of conducting more comprehensive epidemiological studies in terms of more efficient and effective use of pediatric emergency health services in Turkey.
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Affiliation(s)
- Osman Fırat Çalışkan
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Gül Trabzon
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Ufuk Utku Güllü
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Esra Gezmen Yazarlı
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Ferhat Sarı
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Sevcan İpek
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Çiğdem El
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
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Mineva G, Culleton E, Falusi T, Ryan D. Outcomes of abdominal pain among children presenting to the Emergency Department of a tertiary hospital in the Republic of Ireland before and during the COVID-19 pandemic. Ir J Med Sci 2024; 193:1033-1041. [PMID: 37851331 DOI: 10.1007/s11845-023-03547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Acute abdominal pain in paediatric patients is a common presentation to the Emergency Department (ED). The COVID-19 pandemic had a significant impact on the health care sector leading to a decline in hospital attendance. AIMS We compare the burden of paediatric abdominal pain 1 year before and after the start of the COVID-19 pandemic in an Irish ED. METHODS A retrospective cohort study was conducted in a tertiary hospital. Ethical approval was obtained. Data was collected from January 1 to June 30, 2019, and 2021. Patients' charts were accessed using Therefore® software. Key variables were extracted and summarised in Microsoft Excel tables. Univariate and multivariate data analysis were conducted in SPSS® software. RESULTS Six hundred sixty-one (2019) and 479 (2021) patient records were evaluated. There was a 28% reduction in case presentations during pandemic months. Age group, sex and attending discipline were similar for both years. Rates of imaging were significantly higher in 2021 (22.5% vs. 10.6%). Overall admission rate was higher in 2021 (37% vs. 25%, p < 0.001). Viral gastroenteritis decreased (13%) and non-specific diagnosis increased (46%) in 2021. Fewer children re-presented in 2021 (13%). CONCLUSIONS The COVID-19 pandemic had an impact on the presentation, investigations and admission rates of abdominal pain in the ED. Our study highlights the need for increased awareness of severe abdominal pain signs and symptoms in paediatric patients and importance for diagnostic accuracy. Improving patient flow through the ED and having clear guidelines for staff and parents can optimise clinical practice and improve patient outcomes.
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Affiliation(s)
- Gabriela Mineva
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland.
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Emma Culleton
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Tolulope Falusi
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Damien Ryan
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
- ALERT, Emergency Department, University Hospital Limerick, St. Nessan's Road, Limerick, Ireland
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Nicholson E, McDonnell T, Conlon C, De Brún A, Doherty E, Collins C, Bury G, McAuliffe E. Factors that affect GP referral of a child with intellectual disability for a mild illness: A discrete choice experiment. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1241-1250. [PMID: 37489607 DOI: 10.1111/jar.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/26/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND General practitioners (GP) report multiple challenges when treating individuals with intellectual disabilities which may influence referral rates. The study aimed to establish factors that influence GP's decision-making when referring a child with intellectual disabilities to the emergency department. METHOD Discrete choice experiments (DCEs) are increasingly used in health research to further understand complex decision making. A DCE was designed to assess the relative importance of factors that may influence a GP's (N = 157) decision to refer. RESULTS A random parameters model indicated that perceived limited parental capacity to manage an illness was the most important factor in the decision to refer a child to the ED, followed by a repeat visit, a referral request from the parent, and a Friday afternoon appointment. CONCLUSION Understanding the factors that influence referral is important for service improvement and to strengthen primary care provision for this population and their families.
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Affiliation(s)
- Emma Nicholson
- School of Psychology, Dublin City University, Dublin, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Thérèse McDonnell
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Ciara Conlon
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Edel Doherty
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | | | - Gerard Bury
- UCD School of Medicine, UCD College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
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Ye Z, Chen H, Liu X, Wei G. Delayed Care Seeking and Outcomes of Testicular Torsion among Children during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Eur J Pediatr Surg 2023; 33:377-385. [PMID: 36384233 DOI: 10.1055/s-0042-1758153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Since the onset of coronavirus disease 2019 (COVID-19), stay-at-home orders and fear caused by the pandemic have had a significant effect on the timing and outcomes of testicular torsion. However, the evidence was limited since the study results were inconsistent. This study aims to examine the hospitalization rates, timing, and outcomes of testicular torsion in children before and during the pandemic. MATERIALS AND METHODS Using PubMed, Embase, and Google Scholar databases, we conducted a systematic search and meta-analysis of studies reporting the timing and outcomes of children admitted with testicular torsion before and during the COVID-19 pandemic. Subgroup analyses were conducted to explore possible sources of heterogeneity. RESULT The outcomes of 899 testicular torsion patients from eight studies were evaluated. Our study found an increased hospitalization rate for patients with testicular torsion (incidence rate ratio = 1.60, 95% confidence interval [CI]: 1.27-2.03; p = 0.001). Despite a significant increase in the duration of symptoms during the COVID-19 pandemic (weighted mean difference = 11.04, 95% CI: 2.75-19.33; p = 0.009), orchiectomy rates did not increase (odds ratio = 1.33, 95% CI: 0.85-2.10; p = 0.147). CONCLUSION During the COVID-19 pandemic, hospitalization rates for testicular torsion and the duration of symptoms among children increased significantly. Moreover, the rate of orchiectomy did not increase during the pandemic, indicating that pediatric emergency services have remained efficient and have prevented an increase in the number of orchiectomies performed despite pandemic-related closures and delays in transporting patients to medical care.
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Affiliation(s)
- Zihan Ye
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
| | - Hongsong Chen
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
| | - Xing Liu
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
| | - Guanghui Wei
- Department of Urology, Children's Hospital, Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, People's Republic of China
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Breckons M, Thorne S, Walsh R, Bhopal S, Owens S, Rankin J. Parental perspectives on emergency health service use during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study. PLoS One 2023; 18:e0285375. [PMID: 37256845 PMCID: PMC10231793 DOI: 10.1371/journal.pone.0285375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/23/2023] [Indexed: 06/02/2023] Open
Abstract
UK 'Lockdown' measures introduced in March 2020 aimed to mitigate the spread of COVID-19. Although seeking healthcare was still permitted within restrictions, paediatric emergency department attendances reduced dramatically and led to concern over risks caused by delayed presentation. Our aim was to gain insight into healthcare decisions faced by parents during the first wave of the COVID-19 pandemic and to understand if use of urgent healthcare, self-care, and information needs differed during lockdown as well as how parents perceived risks of COVID-19. We undertook qualitative telephone interviews with a purposive sample of parents living in the North East of England recruited through online advertising. We used a semi-structured interview schedule to explore past and current healthcare use, perceptions of risk and the impact of the pandemic on healthcare decisions. Interviews were transcribed and analysed using Thematic Analysis. Three major themes were identified which concerned (i) how parents made sense of risks posed to, and by their children, (ii) understanding information regarding health services and (iii) attempting to make the right decision. These themes contribute to the understanding of the initial impact of COVID-19 and associated restrictions on parental decisions about urgent healthcare for children. These findings are important to consider when planning for potential future public health emergencies but also in the wider context of encouraging appropriate use of urgent healthcare.
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Affiliation(s)
- Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
| | - Sophie Thorne
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rebecca Walsh
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sunil Bhopal
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
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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: 8] [Impact Index Per Article: 8.0] [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.
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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
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Taylor JQ, Krieger R, Blanco R, Austin TM, Abramowicz S. Pediatric Dog Bites to the Face May Have Been Less Severe During COVID-19 Pandemic: A Retrospective Cohort Study. J Oral Maxillofac Surg 2023; 81:575-582. [PMID: 36646135 PMCID: PMC9838755 DOI: 10.1016/j.joms.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Pediatric dog bite injuries are one of the most common nonfatal injuries. During the COVID-19 pandemic, children stayed at home more than pre-pandemic. The effect of the pandemic on severity of dog bites to the face in children has not been examined. The objective of this study was to determine the frequency and severity of dog bite injuries to the face in children during the first year of the COVID-19 pandemic when compared to the previous year. MATERIALS AND METHODS A retrospective cohort study was conducted for children with dog bite injuries to the head and neck region who presented to the emergency department at Children's Healthcare of Atlanta from March 2019 to March 2021. The predictor variable was the time of injury, and this was divided into pre-lockdown [control group (March 15, 2019, to March 15, 2020), ie pre-L] and lockdown (March 15, 2019, to March 15, 2020), ie post-L. The outcome variable was severity of dog bite defined as one or more of the following: 1) patient required sedation or general anesthesia for repair, 2) 3 or more regions in the head and neck were involved, and/or 3) surgical consultation took place. The investigators used a two-sample t-test, multivariable linear regression models, and modified analysis of variance and multivariate ANOVA tests to analyze the data (P-value < .05 determined significance). RESULTS 712 children (370 males) with an average age of 6 years old (range, 7 months-18 years) fit the inclusion criteria. There were 381 cases in the pre-L and 331 in the post-L period. There were more cases on average per month pre-L (31.8 cases/month) than post-L (27.6 cases/month) (P-value = .26). There were 183 pre-L surgical consults compared to 75 post-L (48 vs 22.8% of cases, respectively; P-value ≤ .001). There were 52 pre-L cases that had 3 or more sites in the head and neck compared to 28 during the post-L period (P-value = .032). CONCLUSIONS During the COVID-19 pandemic, there may have been a decrease in the severity of dog bite injuries. This trend may demonstrate a consequence that is not a direct result of the virus.
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Affiliation(s)
- Jeffrey Q. Taylor
- Resident in Training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA,Address correspondence and reprint requests to DrTaylor: Oral and Maxillofacial Surgery, Building B, Suite 2300, 1365 Clifton Road, Atlanta, GA 30322
| | - Rachel Krieger
- Resident in Training, Pediatrics, Emory Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Reena Blanco
- Assistant Professor in Emergency Medicine, Emory University School of Medicine, Associate Medical Director of Emergency Department, Children's Healthcare of Atlanta, Atlanta, GA
| | - Thomas M. Austin
- Associate Professor in Anesthesiology and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Rethi S, Kairam N, Amato CS, Allegra JR, Eskin B. Six Diagnoses of Separation: Impact of COVID-19 on Pediatric Emergency Department Visits: A Multicenter Study. J Emerg Med 2022; 63:723-728. [PMID: 36522811 PMCID: PMC9485421 DOI: 10.1016/j.jemermed.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/28/2022] [Accepted: 09/04/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) arrived in the New York metropolitan area in early March 2020. Recommendations were made to self-quarantine within households and limit outside visits, including those to clinics and hospitals, to limit the spread of the virus. This resulted in a decrease in pediatric emergency department (ED) visits. However, it is unclear how this affected visits for some common diagnoses such as anxiety, appendicitis, asthma, headaches, seizures, and urinary tract infection (UTI). These diagnoses were chosen a priori, as they were felt to represent visits to the ED, for which the diagnoses would likely not be altered based on COVID exposure or quarantine due to their acute nature. OBJECTIVES Our goal was to investigate the effect of COVID-19 on common pediatric diagnoses seen in the pediatric ED using a large multihospital database. METHODS We conducted a retrospective cohort study of consecutive pediatric patients (age ≤ 21 years) between March 1 and November 30 in 2019 and 2020 in 28 hospital EDs within 150 miles of New York City. We compared the change in the number of visits from 2019 to 2020 for the following diagnoses: anxiety, appendicitis, asthma, headache, seizures, and UTI. RESULTS Our database contained 346,230 total pediatric visits. From 2019 to 2020, total visits decreased by 61%. Decreases for specific diagnoses were 75% for asthma, 64% for headaches, 47% for UTI, 32% for anxiety, 28% for seizures, and 18% for appendicitis (p value for each comparison < 0.0001). CONCLUSIONS We found a marked decrease in ED visits for six common pediatric diagnoses after COVID-19 arrived in our area. We suspect that this decrease was due to recommendations to quarantine and fear of contracting the virus. Further studies on other diagnoses and potential complications due to the delay in seeking care are needed.
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Affiliation(s)
- Shruthi Rethi
- Department of Pediatrics, Morristown, New Jersey,Reprint Address: Shruthi Rethi, MD, Department of Pediatrics, Morristown Medical Center, 100 Madison Ave., Morristown, NJ 07960
| | - Neeraja Kairam
- Department of Emergency Medicine, Goryeb Childrenʼs Hospital/Morristown Medical Center, Morristown, New Jersey
| | - Christopher S. Amato
- Department of Emergency Medicine, Goryeb Childrenʼs Hospital/Morristown Medical Center, Morristown, New Jersey
| | - John R. Allegra
- Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey
| | - Barnet Eskin
- Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey
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Appleby G, Papageorgiou V, Horter S, Wharton-Smith A, Sajjanhar T, Hemeson A, Singogo E, Cahill B, Keers S, Wicksey L, Emedo M, Yim A, Nyirenda-Nyang’wa M. Caregiver perceptions and experiences of paediatric emergency department attendance during the COVID-19 pandemic: A mixed-methods study. PLoS One 2022; 17:e0276055. [PMID: 36383622 PMCID: PMC9668109 DOI: 10.1371/journal.pone.0276055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London. Materials and methods We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison. Results Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers’ journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived “overwhelmed” NHS by speaking to trusted sources, predominantly general practitioners (GPs). Conclusion Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child’s health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the hospital safety procedures and the importance of early intervention to caregivers could additionally provide reassurance to those concerned about the risks of accessing the hospital environment.
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Affiliation(s)
- Gayle Appleby
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | - Shona Horter
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tina Sajjanhar
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | | | | | - Sophie Keers
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | | - Marylyn Emedo
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Alastair Yim
- Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Maggie Nyirenda-Nyang’wa
- Lewisham and Greenwich NHS Trust, London, United Kingdom
- The Infection, Immunity and Inflammation Research and Teaching Department, University College London, London, United Kingdom
- * E-mail:
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Cummins NM, Garavan C, Barry LA, Devlin C, Corey G, Cummins F, Ryan D, McCarthy G, Galvin R. The impact of COVID-19 on an Irish Emergency Department (ED): a cross-sectional study exploring the factors influencing ED utilisation prior to and during the pandemic from the patient perspective. BMC Emerg Med 2022; 22:176. [PMID: 36324084 PMCID: PMC9628103 DOI: 10.1186/s12873-022-00720-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The collateral damage of SARS-CoV-2 is a serious concern in the Emergency Medicine (EM) community, specifically in relation to delayed care increasing morbidity and mortality in attendances unrelated to COVID-19. The objectives of this study are to describe the profile of patients attending an Irish ED prior to, and during the pandemic, and to investigate the factors influencing ED utilisation in this cohort. METHODS This was a cross-sectional study with recruitment at three time-points prior to the onset of COVID-19 in December 2019 (n = 47) and February 2020 (n = 57) and post-Lockdown 1 in July 2020 (n = 70). At each time-point all adults presenting over a 24 h period were eligible for inclusion. Clinical data were collected via electronic records and a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors influencing the decision to attend the ED. Data analysis was performed in SPSS and included descriptive and inferential statistics. RESULTS The demographic and clinical profile of patients across time-points was comparable in terms of age (p = 0.904), gender (p = 0.584) and presenting complaint (p = 0.556). Median length of stay in the ED decreased from 7.25 h (IQR 4.18-11.22) in February to 3.86 h (IQR 0.41-9.14) in July (p ≤ 0.005) and differences were observed in disposition (p ≤ 0.001). COVID-19 influenced decision to attend the ED for 31% of patients with 9% delaying presentation. Post-lockdown, patients were less likely to attend the ED for reassurance (p ≤ 0.005), for a second opinion (p ≤ 0.005) or to see a specialist (p ≤ 0.05). CONCLUSIONS Demographic and clinical presentations of ED patients prior to the first COVID-19 lockdown and during the reopening phase were comparable, however, COVID-19 significantly impacted health-seeking behaviour and operational metrics in the ED at this phase of the pandemic. These findings provide useful information for hospitals with regard to pandemic preparedness and also have wider implications for planning of future health service delivery.
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Affiliation(s)
- Niamh M. Cummins
- grid.10049.3c0000 0004 1936 9692School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland ,grid.1002.30000 0004 1936 7857 Department of Paramedicine, Monash University, Melbourne, Australia
| | - Carrie Garavan
- grid.10049.3c0000 0004 1936 9692Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692Present Address: Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Louise A. Barry
- grid.10049.3c0000 0004 1936 9692Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Collette Devlin
- grid.10049.3c0000 0004 1936 9692Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Gillian Corey
- grid.10049.3c0000 0004 1936 9692Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland ,grid.415522.50000 0004 0617 6840ALERT Limerick EM Education Research Training, Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Fergal Cummins
- grid.10049.3c0000 0004 1936 9692School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland ,grid.415522.50000 0004 0617 6840ALERT Limerick EM Education Research Training, Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Damien Ryan
- grid.10049.3c0000 0004 1936 9692School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland ,grid.415522.50000 0004 0617 6840ALERT Limerick EM Education Research Training, Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Gerard McCarthy
- grid.411916.a0000 0004 0617 6269Emergency Department, Cork University Hospital, Cork, Ireland
| | - Rose Galvin
- grid.10049.3c0000 0004 1936 9692Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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11
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Marron L, Burke S, Kavanagh P. Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020. HRB Open Res 2022; 4:67. [PMID: 36204710 PMCID: PMC9513415 DOI: 10.12688/hrbopenres.13307.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. Methods: A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Results: Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). Discussion: While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.
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Affiliation(s)
- Louise Marron
- Department of Public Health HSE East, Dr Steevens’ Hospital, Dublin 8, Ireland,
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Jervis House, Jervis St, Dublin 1, Ireland,Department of Epidemiology and Public Health, Royal College of Surgeons, Dublin 2, Ireland
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12
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Comparison of outcomes in emergency department revisiting patients before and after coronavirus disease 2019 epidemic. Eur J Emerg Med 2022; 29:373-379. [PMID: 35620815 DOI: 10.1097/mej.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND IMPORTANCE The outbreak of COVID-19 challenged the global health system and specifically impacted the emergency departments (EDs). Studying the quality indicators of ED care under COVID-19 has been a necessary task, and ED revisits have been used as an indicator to monitor ED performance. OBJECTIVES The study investigated whether discrepancies existed among ED revisiting cases before and after COVID-19 and whether the COVID-19 epidemic was a predictor of poor outcomes of ED revisits. DESIGN Retrospective study. SETTINGS AND PARTICIPANTS We used electronic health records data from a tertiary medical center. Data of patients with 72-h ED revisit after the COVID-19 epidemic were collected from February 2020 to June 2020 and compared with those of patients before COVID-19, from February 2019 to June 2019. OUTCOME MEASURES AND ANALYSIS The investigated outcomes included hospital admission, ICU admission, out-of-hospital cardiac arrest, and subsequent inhospital mortality. Univariate and multivariate logistic regression models were used to identify independent predictors of 72-h ED revisit outcomes. MAIN RESULTS In total, 1786 patients were enrolled in our study - 765 in the COVID group and 1021 in the non-COVID group. Compared with the non-COVID group, patients in the COVID group were younger (53.9 vs. 56.1 years old; P = 0.002) and more often female (66.1% vs. 47.3%; P < 0.001) and had less escalation of triage level (11.6% vs. 15.0%; P = 0.041). The hospital admission and inhospital mortality rates in the COVID and non-COVID groups were 33.9% vs. 32.0% and 2.7% vs. 1.5%, respectively. In the logistic regression model, the COVID-19 period was significantly associated with inhospital mortality (adjusted odds ratio, 2.289; 95% confidence interval, 1.059-4.948; P = 0.035). CONCLUSION Patients with 72-h ED revisits showed distinct demographic and clinical patterns before and after the COVID-19 epidemic; the COVID-19 period was an independent predictor of increased inhospital mortality.
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13
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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: 1] [Impact Index Per Article: 0.5] [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.
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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
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14
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Ceannt R, Vallieres F, Burns H, Murphy J, Hyland P. Covid-19 vaccine hesitancy and resistance amongst parents of children under 18 years of age in Ireland. Vaccine 2022; 40:6196-6200. [PMID: 36127211 PMCID: PMC9448701 DOI: 10.1016/j.vaccine.2022.08.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022]
Abstract
As COVID-19 vaccination for children becomes commonplace in Ireland, it is important to understand parent’s willingness to vaccinate their children and factors associated with hesitancy and resistance. Amongst a nationally representative sample of parents from Ireland, surveyed in March/April 2021, 52.1% had, or were intending to have their child vaccinated; 30.1% reported they might vaccine their child; and 17.8% reported they would not vaccinate their child. Compared to vaccine-accepting parents, hesitant parents were more likely to be younger, less educated, poorer, to not know somebody who was sick from COVID-19, to believe the COVID-19 vaccines were unsafe, and to hold negative beliefs about scientists and healthcare professionals. Vaccine-resistant parents were more likely to be younger, living alone, to distrust scientists, and to believe the COVID-19 vaccines were unsafe. Public health messaging should target younger, lower income parents with clear information about the safety of COVID-19 vaccines for children.
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Affiliation(s)
- Ruth Ceannt
- Global Health Programme, Health Service Executive, Dr. Steevens' Hospital, Kilmainham, Dublin 8, Ireland.
| | - Frederique Vallieres
- Trinity Centre for Global Health, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland.
| | - Heather Burns
- National Cancer Control Programme, Kings Inns House, 200 Parnell Street, Dublin 1, Ireland.
| | - Jamie Murphy
- School of Psychology, Ulster University, Cromore Road, Coleraine, Co. Londonderry, Northern Ireland.
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.
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15
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McDonnell C, Courtney M, Barrett M, McDonnell T, Persaud T, Twomey E, Harty S, Byrne AT. Impact on the incidence of suspected physical abuse in children under 24 months of age during a global pandemic: A multi-centre Irish regional retrospective cross-sectional analysis. Br J Radiol 2022; 95:20220024. [PMID: 35786972 PMCID: PMC10996961 DOI: 10.1259/bjr.20220024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The advent of the COVID-19 pandemic has resulted in periods of nationwide restrictions in Ireland including school and workplace closures. The authors hypothesised that this disruption to society may have led to a change in patterns of suspected physical abuse (SPA) presentations to the paediatric emergency department (ED), whilst ED attendance fell dramatically during the period. We reviewed data to determine whether there was an increase in presentations of SPA during periods of social restrictions. METHODS The National Integrated Medical Imaging Service was searched for all skeletal survey examinations performed between the dates of the 1 March 2016 and 28 Feb 2021 for studies performed in cases of SPA. Electronic records of attendance were extracted from the emergency department administrative system at the three paediatric emergency departments which serve the 400,000 children regionally. The data were reviewed to determine if SPA presentations increased during restriction periods. RESULTS 311 individual paediatric patients aged 24 months and under were referred for SPA skeletal survey during the study period. During the 2020/2021 period, 60 children were referred for SPA workup and there was no statistically significant difference between monthly referrals (mean 5, sd 2.92) in this period and matched periods over the preceding 4 years (mean 5.23, sd 2.69). CONCLUSIONS The incidence of SPA did not increase during the period of national restrictions during the COVID-19 pandemic. ADVANCES IN KNOWLEDGE Periods of social restrictions taken to protect the public health during a pandemic do not result in short term increases in suspected physical abuse in the regional paediatric population.
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Affiliation(s)
| | | | - Michael Barrett
- Children’s Health Ireland at Crumlin,
Dublin, Ireland
- Women’s and Children’s Health, School of
Medicine, University College Dublin,
Dublin, Ireland
| | - Thérèse McDonnell
- Centre for Interdisciplinary Research Education and Innovation
in Health Systems, UCD School of Nursing, Midwifery & Health
Systems, University College Dublin,
Dublin, Ireland
| | | | - Eilish Twomey
- Children’s Health Ireland at Crumlin,
Dublin, Ireland
| | - Sinead Harty
- Children’s Health Ireland at Crumlin,
Dublin, Ireland
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16
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Bottle A, Neale FK, Foley KA, Viner RM, Kenny S, Aylin P, Saxena S, Hargreaves DS. Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study. BMJ Open 2022; 12:e060961. [PMID: 35940830 PMCID: PMC9364042 DOI: 10.1136/bmjopen-2022-060961] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING All National Health Service (public) hospitals in England. PARTICIPANTS All people in England aged <25 years. OUTCOME MEASURES Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.
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Affiliation(s)
- Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Francesca K Neale
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kimberley A Foley
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Simon Kenny
- National Clinical Director, NHS England and NHS Improvement, London, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study. PLoS Med 2022; 19:e1003974. [PMID: 36026507 PMCID: PMC9467376 DOI: 10.1371/journal.pmed.1003974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/12/2022] [Accepted: 07/28/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. METHODS AND FINDINGS Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. CONCLUSIONS Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. TRIAL REGISTRATION ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258.
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18
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Bell V, McCann A, Power C, Gilchrist E, O'Byrne H, Roulston J, McCrory S, Curtis E, Barrett M, Harty S. Child protection concern in patients during the COVID-19 lockdown. Ir J Med Sci 2022:10.1007/s11845-022-03115-6. [PMID: 35879544 PMCID: PMC9314240 DOI: 10.1007/s11845-022-03115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022]
Abstract
During the COVID-19 lockdown, social isolation from school closures and home visitation restrictions compounded known risk factors for child maltreatment. The aim of our study was to determine the incidence and types of child protection concern (CPC) among inpatients during the COVID-19 lockdown compared to the matched timeframe in 2019. We retrospectively reviewed the CPC assessments performed at Children’s Health Ireland at Crumlin and Tallaght from March 13 to August 31, 2020, and the same period in 2019. Eighty-six versus 163 inpatients were assessed for CPC in 2020 versus 2019. Higher proportions of physical abuse concerns (52.3% versus 11% (p < 0.001)) and emotional abuse concerns (7.0% versus 1.2% (p = 0.015)) were observed in 2020. Case complexity, defined as involving two or more types of CPC, increased with 48.8% in 2020 versus 13.5% in 2019 (p < 0.001). In conclusion, there were fewer assessments for CPC during the 2020 lockdown. However, the complexity of the CPC cases was significantly increased in 2020.
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Affiliation(s)
- Valerie Bell
- Department of General Paediatrics, Children's Health Ireland at Crumlin, Cooley Road, Dublin 12, Dublin, Ireland.
| | - Aisling McCann
- Department of General Paediatrics, Children's Health Ireland at Tallaght, Dublin 24, Dublin, Ireland
| | - Claire Power
- Department of General Paediatrics, Children's Health Ireland at Tallaght, Dublin 24, Dublin, Ireland
| | - Eimear Gilchrist
- Department of Medical Social Work, Children's Health Ireland at Crumlin, Dublin 12, Dublin, Ireland
| | - Helen O'Byrne
- Department of Medical Social Work, Children's Health Ireland at Tallaght, Dublin 24, Dublin, Ireland
| | - Jean Roulston
- Department of Medical Social Work, Children's Health Ireland at Tallaght, Dublin 24, Dublin, Ireland
| | - Sheila McCrory
- Department of Medical Social Work, Children's Health Ireland at Crumlin, Dublin 12, Dublin, Ireland
| | - Emma Curtis
- Department of General Paediatrics, Children's Health Ireland at Tallaght, Dublin 24, Dublin, Ireland
| | - Michael Barrett
- Department of Paediatric Emergency Medicine, Children's Health Ireland at Crumlin, Dublin 12, Dublin, Ireland.,Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sinead Harty
- Department of General Paediatrics, Children's Health Ireland at Crumlin, Cooley Road, Dublin 12, Dublin, Ireland
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19
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Jain V, Clarke J, Beaney T. Association between democratic governance and excess mortality during the COVID-19 pandemic: an observational study. J Epidemiol Community Health 2022; 76:jech-2022-218920. [PMID: 35768188 PMCID: PMC9271843 DOI: 10.1136/jech-2022-218920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Excess mortality has been used to assess the overall health impact of COVID-19 across countries. Democracies aim to build trust in government and enable checks and balances on decision making, which may be useful in a pandemic. But during the pandemic, they have been criticised as being hesitant to enforce restrictive public health measures. METHODS Through linking open-access datasets we constructed univariable and multivariable linear regression models investigating the association between country V-Dem Liberal Democracy Indices (LDI), representing strength of democratic governance and excess mortality rates, from January 2020 to September 2021. We adjusted for several important confounders and conducted a range of sensitivity analyses to assess the robustness of our findings. RESULTS Across 78 countries, 4.19 million deaths million excess deaths were recorded. On multivariable regression, a one-point increase in V-Dem LDI was associated with a decrease in excess mortality of 2.18 per 100 000 (p=0.004), after accounting for age, gender, wealth and universal health coverage. This association was only partially attenuated by COVID-19 vaccination rates and remained robust in all sensitivity analyses. CONCLUSIONS Democratic governance may have played an important role in mitigating the overall health impact of COVID-19 across countries. This study strengthens the case to broaden the scope of traditional pandemic risk assessment and discussions on preparedness.
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Affiliation(s)
- Vageesh Jain
- Institute for Global Health, University College London, London, UK
| | - Jonathan Clarke
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
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20
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Marron L, Burke S, Kavanagh P. Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020. HRB Open Res 2022; 4:67. [DOI: 10.12688/hrbopenres.13307.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. Methods: A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Results: Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). Discussion: While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.
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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.
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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
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22
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Lim E, Kanda M, Rodrigues Z, Hussain R, Lee V. Patient and clinician perspectives of ophthalmology emergency attendances during the COVID 19 pandemic. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022; 25:66-74. [PMID: 38603087 PMCID: PMC9016414 DOI: 10.1177/20534345221092512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction To explore patient and clinician perspectives on acute ophthalmology presentations during the COVID pandemic. To ascertain whether the pandemic had differentially impacted access to care based on patient demographics and postcodes. Methods A single-centre, cross-sectional prospective study in a busy metropolitan eye casualty between April-June 2020 recording patient demographics, distance travelled to access healthcare, diagnosis and outcome compared to the equivalent period in 2019. A further two-part survey was conducted to explore patient and clinician's perceptions around delays in attendances, views on remote consultation and severity of the condition. Results There was a 68% decrease in April 2020 compared to previous year's ED attendance. The diagnosis tended towards more visually significant pathology. From 2019 to 2020, there was a significant decrease in average distance travelled to the eye emergency department (eye ED). working-age adults (18-59) and white patients travelling from very far pre-pandemic contributed most to this change. 513 Patient responses (12%) out of 4433 attendances during the study period were received, 89% (456/513) of the completed surveys also had matching clinician surveys. 29% (149/513) patients felt COVID-19 stopped them from attending earlier. Clinicians thought a video consultation would have been suitable for 40% (182/456) of patients compared to only 13% (58/456) of patients preferring a video consultation. Discussion Although our findings were limited by low response rates, COVID-19 may have caused a delay in presentation for emergency eye care. Demographic changes and attitudes towards video consultations have implications for planning of emergency eye care in future pandemics.
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Affiliation(s)
- Ernest Lim
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mumta Kanda
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Zena Rodrigues
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Rohan Hussain
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vickie Lee
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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23
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Palo SK, Dubey S, Negi S, Sahay MR, Patel K, Swain S, Mishra BK, Bhuyan D, Kanungo S, Som M, Merta BR, Bhattacharya D, Kshatri JS, Pati S. Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review. PLoS One 2022; 17:e0268106. [PMID: 35536838 PMCID: PMC9089853 DOI: 10.1371/journal.pone.0268106] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/22/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Ensuring accessible and quality health care for women and children is an existing challenge, which is further exacerbated during pandemics. There is a knowledge gap about the effect of pandemics on maternal, newborn, and child well-being. This systematic review was conducted to study maternal and child health (MCH) services utilization during pandemics (Zika, Ebola, and COVID-19) and the effectiveness of various interventions undertaken for ensuring utilization of MCH services. METHODOLOGY A systematic and comprehensive search was conducted in MEDLINE/PubMed, Cochrane CENTRAL, Embase, Epistemonikos, ScienceDirect, and Google Scholar. Of 5643 citations, 60 potential studies were finally included for analysis. The included studies were appraised using JBI Critical appraisal tools. Study selection and data extraction were done independently and in duplicate. Findings are presented narratively based on the RMNCHA framework by World Health Organization (WHO). RESULTS Maternal and child health services such as antenatal care (ANC) visits, institutional deliveries, immunization uptake, were greatly affected during a pandemic situation. Innovative approaches in form of health care services through virtual consultation, patient triaging, developing dedicated COVID maternity centers and maternity schools were implemented in different places for ensuring continuity of MCH care during pandemics. None of the studies reported the effectiveness of these interventions during pandemic-related health emergencies. CONCLUSION The findings suggest that during pandemics, MCH care utilization often gets affected. Many innovative interventions were adopted to ensure MCH services. However, they lack evidence about their effectiveness. It is critically important to implement evidence-based appropriate interventions for better MCH care utilization.
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Affiliation(s)
| | - Shubhankar Dubey
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sapna Negi
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Kripalini Patel
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Swagatika Swain
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Dinesh Bhuyan
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Meena Som
- United Nations Children’s Fund (UNICEF), Odisha, India
| | | | | | | | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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24
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Pogorelić Z, Anand S, Artuković L, Krishnan N. Comparison of the outcomes of testicular torsion among children presenting during the Coronavirus Disease 2019 (COVID-19) pandemic versus the pre-pandemic period: A systematic review and meta-analysis. J Pediatr Urol 2022; 18:202-209. [PMID: 35093284 PMCID: PMC8757646 DOI: 10.1016/j.jpurol.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/08/2021] [Accepted: 01/11/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether the Coronavirus Disease 2019 (COVID-19) pandemic resulted in a prolonged duration of symptoms, a delayed presentation to the medical facility, and consequently more orchiectomy procedures among children with testicular torsion compared to the pre-COVID-19 period. METHODS Systematic search of four scientific databases was performed. The search terms used were (coronavirus OR novel coronavirus OR SARS-CoV-2 OR COVID-19) AND (testicular torsion OR orchidectomy OR orchiectomy OR orchidopexy OR orchiopexy). The inclusion criteria were all boys presenting with testicular torsion during the COVID-19 and pre-COVID-19 periods. A comparison of the average duration of symptoms, the proportion of children with delayed presentation (>24 h), and the proportion of children requiring orchiectomy was made among the two groups. The Downs and Black scale was used for methodological quality assessment. RESULTS The present meta-analysis included six comparative studies (five retrospective studies). A total of 711 patients (473 during the COVID-19 period) were included. No significant differences in the average duration of symptoms (WMD: 2.6, 95% CI -6.78 to 11.99, P = 0.59), the proportion of children with delayed presentation (RR = 1.03, 95% CI 0.52-2.02, p = 0.94), and orchiectomy rate (RR = 1.23, 95% CI 0.82-1.84, p = 0.31) were observed among the two patient groups. All studies had a moderate risk of bias. CONCLUSION The duration of symptoms, the proportion of children with delayed presentation, and orchiectomy rate did not significantly differ among the children with testicular torsion presenting during the COVID-19 and pre-COVID-19 periods. However, due to the moderate risk of bias, the level of evidence of the available comparative studies is limited.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split 21000, Croatia; Department of Surgery, University of Split, School of Medicine, Split 21000, Croatia
| | - Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India.
| | - Leon Artuković
- Department of Surgery, University of Split, School of Medicine, Split 21000, Croatia
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
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25
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Murray J, Adamis D, McNicholas F. COVID-19-related occupational stress in staff in an acute paediatric teaching hospital in Ireland. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001308. [PMID: 36053595 PMCID: PMC8914406 DOI: 10.1136/bmjpo-2021-001308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/25/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in major strains for healthcare staff. OBJECTIVES This study aims to assess prevalence of occupational burnout (BO) during COVID-19 in staff working in an acute paediatric hospital setting. PARTICIPANTS One hundred and thirty-three staff, out of 1900 eligible staff (9.6% response rate), completed an online or paper and pencil survey. METHODS The Copenhagen Burnout Inventory was used as the main outcome measure. Additional questions examined the impact of COVID-19 and restrictions on work setting and personal health. RESULTS The majority of respondents reported moderate or higher levels of BO for personal (n=93; 70%) and work domains (n=83; 62%). Rates of patient-related BO were lower (n=18; 13%). Higher rates of BO were found in staff with self-rated COVID-19 adverse effects on physical (n=50, 38%) and mental health (n=88, 66%) (F (2, 13.019)=16.019, p<0.001). The majority of staff had no stress reduction training at any stage in their career, either professional (60%), on the job (62%) or postpandemic (59%) work. Although most (82%) were aware of occupational health supports, few (30%) reported an intention to access these if needed; 65% (n=86) of the respondents seriously considered changing jobs in the last 6-12 months. CONCLUSION High level of occupational stress among hospital staff during COVID-19, in the absence of stress reduction training is a risk factor for BO. Interventions, acceptable to the employee, are urgently needed given the likelihood of additional work demands as COVID-19 continues.
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Affiliation(s)
| | - Dimitrios Adamis
- Medicine, Mental Health Services Sligo/Leitrim and West Cavan, Sligo, Ireland
| | - Fiona McNicholas
- Psychiatry, Lucena Clinic Services, Dublin, Ireland.,Child and Adolescent Psychiatry, Our Lady's Hospital Crumlin, Crumlin, Ireland.,Medicine, University College Dublin-National University of Ireland, Dublin, Ireland
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26
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Power E, Taaffe S, McLoughlin P, Sharif F. Primary and secondary care approach to paediatric mental health conditions: a novel model of care. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001285. [PMID: 36053655 PMCID: PMC8905931 DOI: 10.1136/bmjpo-2021-001285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/14/2022] [Indexed: 11/03/2022] Open
Abstract
The enforced isolation caused by the COVID-19 pandemic has led to an increase in mental health issues and severity of presentations to emergency departments in Ireland. Long waiting lists for both Psychology and Psychiatry are further impacting on children's mental well-being. We proposed the creation of a 'Happiness Toolkit' that can be given to children on presentation to their primary or secondary care provider with a mental health issue. The toolkit is comprised of six evidence-based techniques that are proven to boost self-esteem, develop resilience and promote positive mental health. A leaflet detailing the practices along with a physical 'box' that the children must make were created. This resource may therefore provide immediate support to those children that may endure long waiting periods, sometimes greater than a year and a half, for referral to tertiary services. Our toolkit allows children and their families to engage in positive mental health practices that may prevent regression during this waiting period and lead to improved mental health or cessation of symptoms.
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Affiliation(s)
- Edmond Power
- University Hospital Limerick, Dooradoyle, Limerick, Ireland .,Department of Paediatrics, UCD School of Medicine, Dublin, Ireland
| | - Sarah Taaffe
- Irish College of General Practitioners, Dublin, Ireland
| | | | - Farhana Sharif
- Department of Paediatrics, UCD School of Medicine, Dublin, Ireland.,Department of Paediatrics, Midland Regional Hospital Mullingar, Mullingar, Westmeath, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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27
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McDonnell T, Conlon C, McNicholas F, Barrett E, Barrett M, Cummins F, Hensey C, McAuliffe E, Nicholson E. Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic. Int Rev Psychiatry 2022; 34:128-139. [PMID: 35699100 DOI: 10.1080/09540261.2022.2061840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Increases in youth psychiatric presentations to out-patient and emergency department settings during COVID-19 have been reported. This study, using data from five hospitals in Ireland, examines changes in the number and type of paediatric admissions during COVID-19 (March 2020 - February 2021) compared to the previous two years. ICD-10 classification was used to establish admissions with mental, behavioural, neuro-developmental disorders and psychosocial reasons (MBN-PS). Overall hospital admissions fell by 25.3%, while MBN-PS fell by only 2.6%, mostly during an initial lockdown. Admissions for MBN-PS increased in July-August (9.2%), increased further in September-December (28.3%), returning to pre-COVID-19 levels in January-February 2021. Significant increases were observed among youths with anorexia nervosa (47.8%), other eating disorders (42.9%), and admissions for anxiety (29.6%), with these effects relating to females only. Although admissions for self-harm increased (3%) and rates of ASD admissions reduced (17%), these were not statistically significant. The disproportionate increase in admissions for MBN-PS compared to medical admissions suggests an adverse effect of COVID-19 on youth mental health, for females in particular, and supports previous reports of a pandemic specific increase in eating psychopathology. Combined community and acute service delivery and capacity planning are urgently needed given the prior underfunding of services pre-pandemic.
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Affiliation(s)
- T McDonnell
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - C Conlon
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - F McNicholas
- Children's Health Ireland at Crumlin, Dublin, Ireland.,UCD Child and Adolescent Psychiatry, University College Dublin, Belfield, Ireland.,Lucena Clinic, Rathgar, Ireland
| | - E Barrett
- UCD Child and Adolescent Psychiatry, University College Dublin, Belfield, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland
| | - M Barrett
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - F Cummins
- ALERT, REDSPOT, Emergency Department, Limerick University Hospital, Limerick, Ireland
| | - C Hensey
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - E McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - E Nicholson
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Dublin City University, Dublin, Ireland
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28
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Radiology referrals from the emergency department during the United Kingdom lockdown of 2020. Pediatr Radiol 2022; 52:1407-1408. [PMID: 35290488 PMCID: PMC8920802 DOI: 10.1007/s00247-022-05342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/03/2022]
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Randall MM, Despujos Harfouche F, Raae-Nielsen J, Chen BG, Chen M, Brown LA. COVID-19 Restrictions Are Associated With a Significant Decrease of All Common Respiratory Viral Illnesses in Children. Clin Pediatr (Phila) 2022; 61:22-25. [PMID: 34643469 PMCID: PMC8685736 DOI: 10.1177/00099228211044842] [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] [Indexed: 11/16/2022]
Abstract
To combat the spread of coronavirus disease 2019 (COVID-19), significant measures were enacted including school and business closures, social distancing, and facial coverings. We hypothesized that this would have an impact on all respiratory infections in children. Using nasopharyngeal panel test results of children in the emergency department, we evaluated cross-sectional data from February to May in both 2019 and 2020. Respiratory panel testing included 11 common respiratory viruses and bacteria. After the restrictions were enacted, we observed a large drop in the number and percentage positive of all common respiratory viral infections in 2020 compared with the same time in 2019. When analyzing data from children <2 years old, a similar decrease was seen. Restrictions enacted to prevent the spread of COVID-19 were associated with a significant decrease in respiratory viral infections in children of all ages. This association could guide future public health recommendations and guidelines.
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Affiliation(s)
- Melanie M. Randall
- Loma Linda University Medical Center, Loma Linda, CA, USA,Melanie M. Randall, Department of Emergency Medicine, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | | | | | - Brian G. Chen
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Lance A. Brown
- Loma Linda University Medical Center, Loma Linda, CA, USA
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30
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Brown A, Collingwood P, Newton JL. Cohort study to explore the association between the COVID-19 pandemic lockdown and admissions for violence in North East and North Cumbria. BMJ Open 2021; 11:e052923. [PMID: 34930739 PMCID: PMC8688732 DOI: 10.1136/bmjopen-2021-052923] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Explore the association between the first national lockdown associated with the COVID-19 pandemic on admissions for violence and the relationship with deprivation. DESIGN Population-based longitudinal cohort study. SETTING North East and North Cumbria (NENC) area of England. PARTICIPANTS All individuals living in the NENC (total population 3.1 million) admitted 2017/2018, 2018/2019, 2019/2020. MAIN OUTCOME MEASURES Hospital Episode Statistics were extracted at Lower Layer Super Output Area and the Index of Multiple Deprivation 2019 decile applied. Directly standardised rates were explored for number of accident and emergency (A&E) attendances (per 1000); Alcohol-related admissions using Public Health England (PHE) Fingertips tool (per 100 000, ID 91414) and emergency admissions for violence (including sexual violence) (per 100 000) (ID 11201 classified by International Classification of Diseases (ICD)10 codes X85 to Y09). RESULTS A&E attendances are higher in NENC compared with England (409.9 per 1000 v 359.2). A&E attendance was 81% higher in 2019/20 in the most deprived compared with the least deprived. Attendances dropped during the first national COVID-19 lockdown and by September 2020 had not returned to 'normal' levels.Admissions related to violence are a third higher in NENC (29% to 34% higher across 3 years) rates 7-10 times higher in most deprived than least deprived areas. Admission rates reduced during the first UK lock down but this bounced back by August higher than any of the previous 12 months. CONCLUSION Emergency admissions with violence appear to associate with the COVID-19 pandemic being initially higher than before the first national lockdown. This is in the context of overall A&E attendances which are lower post lockdown. Given that emergency admissions with violence have been consistently higher in the NENC compared with England over recent years, we suggest that targeted action is required in NENC to address health inequalities.
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Affiliation(s)
- Andrea Brown
- The North East Quality Observatory Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul Collingwood
- The North East Quality Observatory Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julia L Newton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Academic Health Science Network North East and North Cumbria, Newcastle upon Tyne, UK
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31
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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.
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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
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Wallis Gómez VG, Apolinario MH, Saavedra Santana P, Pérez CH, Rueda NR, Rubino CT, Ferrer LZ, Peña-Quintana L. Evaluation of changes in pediatric healthcare activity during the Covid-19 state of alarm in the Canary Islands. PUBLIC HEALTH IN PRACTICE 2021; 2:100159. [PMID: 34841373 PMCID: PMC8608396 DOI: 10.1016/j.puhip.2021.100159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE During the SARS-CoV-2 state of alarm (SoA), a 30-70% reduction was observed in the number of visits to Pediatric Emergency Departments (ED), as well as frequent delay in diagnosis or difficulty accessing healthcare services. Here we evaluate modifications observed in pediatric healthcare activity during the SoA. STUDY DESIGN Descriptive retrospective observational study of the hospital pediatric activity. METHOD We compared the use of pediatric healthcare services during the SoA (March 11th - June 25th, 2020) versus the use during the equivalent periods of years 2018 and 2019, in the "Complejo Hospitalario Universitario Insular Materno Infantil de Canarias" (Mother and Child University Hospital of the Canary Islands). RESULTS The number of patients visiting the pediatric ED decreased by 66.75% on average (95%CI: -65.6; - 67.7; p < 0.001), with a peak reduction (70.4%; 95%CI: -69.0; -71.7; p < 0.001) during the lockdown. We observed an increase in the number of cases of psychiatric disorders, foreign body ingestions and intoxications, as well as a decrease in respiratory conditions. Hospital admissions decreased by 45.5% (95%CI: - 38.9; -51.3; p < 0.001), while the ratio and duration of hospital stay increased. A proportion of 3.95% of admitted patients experienced complications caused by delayed visit to the ED. CONCLUSIONS The study shows that more patient education campaigns are needed to improve the efficiency of emergency services. It is important to reinforce the message that adequate healthcare service management is necessary.
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Affiliation(s)
- Valewska G. Wallis Gómez
- Servicio de Pediatría. Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (CHUIMI), 35016, Gran Canaria, Spain
| | - María Hernández Apolinario
- Servicio de Pediatría. Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (CHUIMI), 35016, Gran Canaria, Spain
| | | | - Claudia Hernández Pérez
- Servicio de Pediatría. Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (CHUIMI), 35016, Gran Canaria, Spain
| | - Natalia Ramos Rueda
- Servicio de Pediatría. Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (CHUIMI), 35016, Gran Canaria, Spain
| | - Carla Taboada Rubino
- Servicio de Pediatría. Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (CHUIMI), 35016, Gran Canaria, Spain
| | - Laura Zapata Ferrer
- Servicio de Pediatría. Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (CHUIMI), 35016, Gran Canaria, Spain
| | - Luis Peña-Quintana
- Servicio de Pediatría. Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (CHUIMI), 35016, Gran Canaria, Spain
- Universidad de Las Palmas de Gran Canaria, 35017, Gran Canaria, Spain
- Asociación Canaria para La Investigación Pediátrica, Gran Canaria, Spain
- CIBER OBN, Spain
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33
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Carison A, Babl FE, O'Donnell SM. Increased paediatric emergency mental health and suicidality presentations during COVID-19 stay at home restrictions. Emerg Med Australas 2021; 34:85-91. [PMID: 34708565 PMCID: PMC8652435 DOI: 10.1111/1742-6723.13901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
Objective Anecdotal reports indicate an increase in mental health presentations and acuity to EDs during the COVID‐19 pandemic and associated stay at home restrictions. Paediatric and adolescent data to confirm this are unavailable in the Australian setting. Methods Retrospective electronic medical record review of all ED patients with mental health discharge codes at a large tertiary children's hospital in Australia during the period of stay at home restrictions from 1 April to 30 September 2020 compared with the same dates in 2019. Results We found a 40% decrease in ED presentations (18 935–11 235) with a concurrent 47% increase in mental health presentations (809–1190) to ED during the study periods between 2019 and 2020. This resulted in an increase of 100 mental health admissions from ED. Diagnoses with greatest percentage increases were eating disorders, social issues and suicidality. We found suicidality presentation numbers were highest in June to September 2020 compared with 2019. Patients with a diagnosis of suicidality had a higher rate of re‐presentation in 2020 (1.83 presentations per patient) compared to 2019 (1.38 presentations per patient). Conclusions Despite an overall decrease in ED presentations, the absolute increase in mental health presentations for children and adolescents during the stay at home restriction period was pronounced. It is unclear how sustained this change and the impact on mental health resource use will be post‐pandemic.
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Affiliation(s)
- Anna Carison
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sinead M O'Donnell
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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34
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Dandena F, Teklewold B, Anteneh D. Impact of COVID-19 and mitigation plans on essential health services: institutional experience of a hospital in Ethiopia. BMC Health Serv Res 2021; 21:1105. [PMID: 34654411 PMCID: PMC8519745 DOI: 10.1186/s12913-021-07106-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background Health systems around the world are being challenged by an on-going COVID-19 pandemic. The COVID-19 pandemic and associated response can have a significant downstream effect on access to routine health care services, and indirectly cause morbidity and mortality from causes other than the disease itself, especially in resource-poor countries such as Ethiopia. This study aimed to explore the impact of the pandemic on these services and measures taken to combat the effect. Methods The study was conducted at St. Paul’s hospital millennium medical college (SPHMMC) from December 15, 2020 to January 15, 2021 using a comparative cross-sectional study design. We collected data on the number of clients getting different essential health care services from May to October 2019 (Pre COVID) and the same period in 2020 (during a COVID-19 pandemic) from the patient registry book. The analysis was done with SPSS version 24 software. Result Overall, the essential services of SPHMMC were affected by the COVID-19 pandemic. The most affected service is inpatient admission, which showed a 73.3% (2044 to 682) reduction from the pre-COVID period and the least affected is maternal service, which only decreased by 13% (3671 to 3177). During the 6 months after the COVID-19 pandemic, there was a progressive increment in the number of clients getting essential health services. Conclusion and recommendation The establishment of a triple setup for fighting against COVID-19, which encompasses non-COVID services, an isolation center and a COVID-19 treatment center, played a vital role in preserving essential health services.
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Affiliation(s)
- Firaol Dandena
- Department of Surgery, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Berhanetsehay Teklewold
- Department of Surgery, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dagmawi Anteneh
- Saint Paul Hospital Millennium Medical College, Quality Improvement and Clinical Governance Directorate, Addis Ababa, Ethiopia
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35
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Lazova S, Velikova T. DYNAMICS OF CHILDHOOD RESPIRATORY INFECTIONS DURING THE COVID-19 PANDEMIC: THE EFFECT OF QUARANTINE АND BEYOND. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.3.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Monitoring epidemic processes and the dynamics of the spread of infectious diseases is essential for predicting their distribution and effective planning in healthcare. The importance of studying seasonal trends in the spread of respiratory viral infections and the specific effects of non-pharmaceutical interventions in nationwide scales and the use of available vaccines stand out even more in the context of the coronavirus disease-19 (COVID-19) pandemic. Even if the dynamics of pediatric respiratory viral infections show some variation at the national and local levels, depending on health regulation, respiratory viral pathogens follow a typical pattern of incidence. Therefore, we hypothesize that anticipated reduction of the incidence of common respiratory viral infections would undoubtedly exert positive effects, such as ease of burdening healthcare that combates the COVID-19 pandemic. However, we suspect a shift in familiar seasonal characteristics of common respiratory viral infections. We also speculate that strict long-term limitations of the natural spread of respiratory viral infections can lead to the development of hard-to-predict epidemiological outliers. Additionally, the tricky balance between humanity’s natural impulse to return to normalcy and control the new and still dynamically evolving infection could lead to new threats from old and well-known pathogens. Finally, we hypothesize that the absence of regular influenza virus circulation may lead to a high mismatch rate and a significant reduction in flu vaccine efficacy.
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36
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Rusconi F, Di Fabrizio V, Puglia M, Sica M, De Santis R, Masi S, Gagliardi L. Delayed presentation of children to the emergency department during the first wave of COVID-19 pandemic in Italy: Area-based cohort study. Acta Paediatr 2021; 110:2796-2801. [PMID: 34214214 PMCID: PMC8444882 DOI: 10.1111/apa.16019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022]
Abstract
Aim To ascertain a delay in attendances to the emergency department (ED) during 2020 lockdown. Methods Area‐based cohort study on paediatric (0‐15 years) attendances resulting in hospital admission in Tuscany, Italy, in February‐May 2020, and the corresponding periods in 2018‐19. We analysed times from symptom onset to arrival, the odds of arriving late (>90th centile of time) and paediatricians’ judgements of a late presentation by logistic models. Results As expected, ED attendance fell sharply (−62%) in 2020 vs 2018‐19. As for cases studied (455 in 2020 and 1161 in 2018–19), we documented a delay in arrival to the ED in 2020 versus 2018–19 for several groups of diagnoses, namely gastroenteritis, sepsis, wounds, burns and infections overall. Time to presentation over 90th centile was also higher in 2020 (odds ratio, OR: 1.44; 95% confidence interval: 1.00, 2.06), as were paediatricians’ judgements of a late arrival (18.9% of cases in 2020 vs. 13.4% in 2018‐19; OR: 1.58; 1.14, 2.19) Conclusion In a population‐based cohort, delayed attendances to ED ascertained both subjectively and objectively convey the message to families and to paediatricians to seek hospital care in case of severe or unremitting symptoms and not to wait longer than they normally would.
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Affiliation(s)
- Franca Rusconi
- Unit of Epidemiology Meyer Children’s University Hospital Florence Italy
- Unit of Epidemiology Regional Health Agency of Tuscany Florence Italy
| | | | - Monia Puglia
- Unit of Epidemiology Regional Health Agency of Tuscany Florence Italy
| | - Michela Sica
- Unit of Epidemiology Meyer Children’s University Hospital Florence Italy
| | - Rita De Santis
- Department of Emergency Medicine and Trauma Center Meyer Children's University Hospital Florence Italy
| | - Stefano Masi
- Department of Emergency Medicine and Trauma Center Meyer Children's University Hospital Florence Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics Versilia Hospital Viareggio Italy
- Azienda USL Toscana Nord Ovest Pisa Italy
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37
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Duncanson M, Wheeler BJ, Jelleyman T, Dalziel SR, McIntyre P. Delayed access to care and late presentations in children during the COVID-19 pandemic New Zealand-wide lockdown: A New Zealand Paediatric Surveillance Unit study. J Paediatr Child Health 2021; 57:1600-1604. [PMID: 34003540 PMCID: PMC8242550 DOI: 10.1111/jpc.15551] [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: 03/04/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
AIM Describe paediatricians' experience of adverse health outcomes for children during the New Zealand-wide level 4 lockdown in response to the COVID-19 pandemic. METHODS Weekly national survey of paediatricians with an open-ended questionnaire. RESULTS During the 6-week study survey period, the New Zealand Paediatric Surveillance Unit received 33 reports about 55 instances where paediatricians believed care may have been compromised, about half (56%) relating to infants aged from birth to 6 weeks. Compromised care was for acute presentations in 75%, acute complications of a chronic illness in 14%, with 11% for chronic conditions. Paediatricians reported the outcome as moderately severe (short-term morbidity, increased length of stay, higher level of care) in 38 cases (69%) and in a further 4 (7%) as severe (potential to be life-threatening or result in permanent disability). CONCLUSION Despite clear messaging, hospital avoidance and reduced access to primary and secondary care were associated with significant potential harm for children in New Zealand during a strict lockdown, with newborn infants disproportionately affected. During the implementation of interventions to eliminate community transmission of COVID-19, New Zealand paediatricians note the importance of face-to-face post-natal visits for newborns and primary care services for children with acute illness, to avoid preventable harm.
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Affiliation(s)
- Mavis Duncanson
- Department of Women's and Children's HealthDunedin School of Medicine, University of OtagoDunedinNew Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's HealthDunedin School of Medicine, University of OtagoDunedinNew Zealand
| | - Timothy Jelleyman
- Child and Youth Team, Population Health and Prevention DirectorateNew Zealand Ministry of HealthWellingtonNew Zealand
| | - Stuart R Dalziel
- Department of SurgeryThe University of AucklandAucklandNew Zealand,Department of Paediatrics: Child and Youth HealthThe University of AucklandAucklandNew Zealand,Children's Emergency DepartmentStarship Children's HealthAucklandNew Zealand
| | - Peter McIntyre
- Department of Women's and Children's HealthDunedin School of Medicine, University of OtagoDunedinNew Zealand
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38
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Fox R, Mulcahy Symmons S, De Brún A, Joyce D, Muldoon EG, McGinty T, O'Reilly KMA, O'Connor E, McAuliffe E. Mixed methods protocol to examine the acceptability and clinical characteristics of a remote monitoring programme for delivery of COVID-19 care, among healthcare staff and patients. BMJ Open 2021; 11:e051408. [PMID: 34588258 PMCID: PMC8482534 DOI: 10.1136/bmjopen-2021-051408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The use of remote monitoring technology to manage the care of patients with COVID-19 has been implemented to help reduce the burden placed on healthcare systems during the pandemic and protect the well-being of both staff and patients. Remote monitoring allows patients to record their signs and symptoms remotely (eg, while self-isolating at home) rather than requiring hospitalisation. Healthcare staff can, therefore, continually monitor their symptoms and be notified when the patient is showing signs of clinical deterioration. However, given the recency of the COVID-19 outbreak, there is a lack of research regarding the acceptance of remote monitoring interventions to manage COVID-19. This study will aim to evaluate the use of remote monitoring for managing COVID-19 cases from the perspective of both the patient and healthcare staff. METHODS AND ANALYSIS Discharged patients from a large urban teaching hospital in Ireland, who have undergone remote monitoring for COVID-19, will be recruited to take part in a cross-sectional study consisting of a quantitative survey and a qualitative interview. A mixed methods design will be used to understand the experiences of remote monitoring from the perspective of the patient. Healthcare staff who have been involved in the provision of remote monitoring of patients with COVID-19 will be recruited to take part in a qualitative interview to understand their experiences with the process. Structural equation modelling will be used to examine the acceptance of the remote monitoring technology. Latent class analysis will be used to identify COVID-19 symptom profiles. Interview data will be examined using thematic analysis. ETHICS AND DISSEMINATION Ethical approval has been granted by the ethical review boards at University College Dublin and the National Research Ethics Committee for COVID-19-related Research. Findings will be disseminated via publications in scientific journals, policy briefs, short reports and social media.
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Affiliation(s)
- Robert Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sophie Mulcahy Symmons
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - David Joyce
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eavan G Muldoon
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Tara McGinty
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Katherine M A O'Reilly
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eileen O'Connor
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Elrod J, Mahaleh S, Mohr C, Boettcher M, Dietze N, Hübner U, Koch B, Steinbrink A, Harandipour N, Gräfin von Waldersee E, Shahsavari S, Reinshagen K, Königs I. [Impact and Temporal Evolution of the Corona Pandemic on Pediatric Emergency Care]. KLINISCHE PADIATRIE 2021; 234:33-41. [PMID: 34530471 DOI: 10.1055/a-1519-5928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HINTERGRUND Die COVID-19 Pandemie hat zu massiven gesellschaftlichen und wirtschaftlichen Einschränkungen geführt. Im Kindesalter wurden elektive Vorsorgeuntersuchung oftmals nicht wahrgenommen und es zeigte sich eine Reduktion der Zahl der Notfallvorstellungen. MATERIAL UND METHODEN In einer retrospektiven Studie erfolgte eine quantitative Auswertung aller Notfallpatienten der 5 Kindernotaufnahmen Hamburgs und der Kinder- und Jugendarztpraxen der Jahre 2019 und 2020. Zusätzlich erfolgte die detaillierte Analyse der Notfallbehandlungen des Altonaer Kinderkrankenhauses während der ersten Phase der Pandemie im Vergleich zum Vorjahr. Zusammenhänge zu den Eckpunkten der Pandemieentwicklung wurden analysiert. Die Berechnung signifikanter Unterschiede in Bezug auf die demographischen Daten und Krankheitsbilder erfolgte mittels Chi- Quadrat und t-Test. ERGEBNISSE In allen 5 pädiatrischen Notaufnahmen Hamburgs zeigte sich eine nahezu gleichförmige Abnahme der Patientenvorstellungen während der Pandemie, ähnlich in den Kinder- und Jugendarztpraxen. Die Zahl der Behandlungen verhielt sich dabei nicht streng gegenläufig zu den Neuinfektionen, sondern korreliert eher mit den Mobilitätsdaten und entsprach somit den gesamtgesellschaftlichen Veränderungen. Während der Pandemie stieg der Anteil häuslicher Unfälle an der Gesamtzahl der Vorstellungen signifikant an. Die Analyse der Diagnosen zeigte unter anderem eine relative Abnahme von (viralen) Infektionskrankheiten. Nicht behandlungspflichtige Erkrankungen führten in der Pandemie seltener zur Vorstellung. Diese Phänomene entlasteten einerseits die Notaufnahmen, bergen aber auch die Gefahr, dass Erkrankungen durch Eltern falsch eingeschätzt werden und eine notwendige ärztliche Vorstellung somit zu spät erfolgt.
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Affiliation(s)
- Julia Elrod
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Simin Mahaleh
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland
| | - Christoph Mohr
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Michael Boettcher
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Nina Dietze
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Uwe Hübner
- Departments of Paediatric Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Deutschland
| | - Bernward Koch
- KinderHeidberg, Department of Pediatric Surgery, Asklepios Klinik Nord Heidberg, Hamburg, Deutschland
| | - Annika Steinbrink
- Department of Pediatric Surgery, Helios Mariahilf Klinik Hamburg, Hamburg, Deutschland
| | - Nasanin Harandipour
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland
| | | | - Sadaf Shahsavari
- Clinic and Polyclinic for Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Konrad Reinshagen
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
| | - Ingo Königs
- Department of Pediatric Surgery, AKK Altona Children's Hospital, Hamburg, Deutschland.,Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, UKE Medical School, Hamburg, Deutschland
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An Online Cross-Sectional Survey of Complementary Feeding Practices during the COVID-19 Restrictions in Poland. Nutrients 2021; 13:nu13093196. [PMID: 34579073 PMCID: PMC8471223 DOI: 10.3390/nu13093196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 01/04/2023] Open
Abstract
This cross-sectional online survey performed in Poland aimed to improve understanding of how COVID-19 pandemic restrictions affected complementary feeding practices among parents of infants aged 4 to 12 months. Self-selected parents were recruited through the internet. The anonymous questionnaire was opened during two intervals during COVID-19 restrictions. The primary outcome was an assessment of sources of information and infant feeding practices in the context of COVID-19 restrictions. Data from 6934 responders (92.2% mothers) were analyzed. Most responders received information from multiple sources, with other parents, family members, or friends being the most frequently reported (48.6%), followed by webinars and experts’ recommendations (40.8%). COVID-19 restrictions largely did not impact the method of feeding, changes in feeding patterns, or complementary feeding introduction, although the latter was more likely to be impacted in families with average versus the best financial situations. Multivariate logistic regression analysis also most consistently showed that parents with a tertiary education and living in a city above 500 k were at higher odds of using webinars/experts’ recommendations, internet/apps, and professional expert guides and lower odds of claiming no need to deepen knowledge. This study clarifies major issues associated with complementary feeding practices during the implementation of COVID-19 restrictions in Poland.
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Castany E, Marti C, Parra C, Goldman R, Luaces C. Expectations of Patients Seen in the Emergency Department for SARS-CoV-2 During the Pandemic. Clin Pediatr (Phila) 2021; 60:405-407. [PMID: 34192944 DOI: 10.1177/00099228211029821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Cristina Parra
- Hospital Sant Joan de Déu, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Ran Goldman
- University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Carles Luaces
- Hospital Sant Joan de Déu, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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Toppi J, Hughes J, Phillips D. Bacterial infections of the oropharynx and deep neck spaces: an investigation of changes in presentation patterns during the COVID-19 pandemic. ANZ J Surg 2021; 91:2726-2730. [PMID: 34427384 PMCID: PMC8646372 DOI: 10.1111/ans.17178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/07/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Background The aim of this study was to investigate whether changes in practice during the COVID‐19 pandemic altered clinical presentation characteristics among adults with bacterial throat infections. Methods A retrospective cohort study was conducted that included adult patients presenting with bacterial oropharyngeal infections to a tertiary level hospital in Melbourne, Australia. All patients presenting during the first phase of COVID‐19 lockdown in Melbourne (1st April– 1st July in 2020), and those from the same period 12‐months prior, were included. Results There were fewer presentations of bacterial throat infections during the pandemic period compared to the same time 1 year prior. There was a significantly reduced proportion of patients on oral antibiotics prior to their presentation in 2020, as compared to the same period 12‐months earlier (30% vs. 50%, respectively; P < 0.01), as well as a significant increase in the length of time patients were symptomatic before presenting to hospital (5 days vs. 4 days, respectively; P < 0.01). Despite this, there was no significant increase in the number of representations post discharge from hospital, or the length of hospital admission. Conclusion The overall number of patients presenting with tonsillitis, pharyngitis, peritonsillar abscess and deep neck space infection were reduced during the pandemic period. Patients experienced symptoms for a longer period of time and fewer were on antimicrobial therapy prior to presentation. This study highlights a shift towards delayed patient presentation and reduced oral antibiotic commencement in cases of oropharyngeal infections as a result of the COVID‐19 pandemic.
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Affiliation(s)
- Jason Toppi
- Otolaryngology and Head and Neck Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Otolaryngology and Head and Neck Unit, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jed Hughes
- Otolaryngology and Head and Neck Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Damien Phillips
- Otolaryngology and Head and Neck Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Otolaryngology and Head and Neck Unit, Royal Children's Hospital, Parkville, Victoria, Australia
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Huang HCH, Ougrin D. Impact of the COVID-19 pandemic on child and adolescent mental health services. BJPsych Open 2021; 7:e145. [PMID: 34348823 PMCID: PMC8353214 DOI: 10.1192/bjo.2021.976] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic and government lockdown restrictions have had an impact on children and young people worldwide. In this editorial, we explore how and why referrals to UK children and adolescent mental health services (CAMHS) have changed during the pandemic and summarise the emerging data on the potential reasons behind this.
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Affiliation(s)
| | - Dennis Ougrin
- Institute of Psychiatry, Child and Adolescent Psychiatry, King's College London, UK
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Finkelstein Y, Maguire B, Zemek R, Osmanlliu E, Kam AJ, Dixon A, Desai N, Sawyer S, Emsley J, Lynch T, Mater A, Schuh S, Rumantir M, Freedman SB. Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study. Pediatr Emerg Care 2021; 37:427-434. [PMID: 34074990 PMCID: PMC8327936 DOI: 10.1097/pec.0000000000002484] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to quantify the effect of the COVID-19 pandemic on pediatric emergency department (ED) utilization and outcomes. METHODS This study is an interrupted-time-series observational study of children presenting to 11 Canadian tertiary-care pediatric EDs. Data were grouped into weeks in 3 study periods: prepandemic (January 1, 2018-January 27, 2020), peripandemic (January 28, 2020-March 10, 2020), and early pandemic (March 11, 2020-April 30, 2020). These periods were compared with the same time intervals in the 2 preceding calendar years. Primary outcomes were number of ED visits per week. The secondary outcomes were triage acuity, hospitalization, intensive care unit (ICU) admission, mortality, length of hospital stay, ED revisits, and visits for trauma and mental health concerns. RESULTS There were 577,807 ED visits (median age, 4.5 years; 52.9% male). Relative to the prepandemic period, there was a reduction [-58%; 95% confidence interval (CI), -63% to -51%] in the number of ED visits during the early-pandemic period, with concomitant higher acuity. There was a concurrent increase in the proportion of ward [odds ratio (OR), 1.39; 95% CI, 1.32-1.45] and intensive care unit (OR, 1.20; 95% CI, 1.01-1.42) admissions, and trauma-related ED visits among children less than 10 years (OR, 1.51; 95% CI, 1.45-1.56). Mental health-related visits in children declined in the early-pandemic period (in <10 years, -60%; 95% CI, -67% to -51%; in children ≥10 years: -56%; 95% CI, -63% to -47%) relative to the pre-COVID-19 period. There were no differences in mortality or length of stay; however, ED revisits within 72 hours were reduced during the early-pandemic period (percent change: -55%; 95% CI, -61% to -49%; P < 0.001). CONCLUSIONS After the declaration of the COVID-19 pandemic, dramatic reductions in pediatric ED visits occurred across Canada. Children seeking ED care were sicker, and there was an increase in trauma-related visits among children more than 10 years of age, whereas mental health visits declined during the early-pandemic period. When faced with a future pandemic, public health officials must consider the impact of the illness and the measures implemented on children's health and acute care needs.
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Affiliation(s)
- Yaron Finkelstein
- From the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology
| | - Bryan Maguire
- Biostatistical Design and Analysis team, The Hospital for Sick Children, University of Toronto, Toronto
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Esli Osmanlliu
- Division of Pediatric Emergency Medicine, Montreal Children’s Hospital, McGill University, Montreal, Quebec
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario
| | - Andrew Dixon
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | - Neil Desai
- Division of Pediatric Emergency Medicine, British Columbia Children’s Hospital, Vancouver, British Columbia
| | - Scott Sawyer
- Department of Pediatrics and Emergency Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Jason Emsley
- Department of Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia
| | - Tim Lynch
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Schulich School of Medicine, Western University, London, Ontario
| | - Ahmed Mater
- Division Pediatric Emergency Medicine, Jim Pattison Children’s Hospital, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Maggie Rumantir
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Holzman SA, Ahn JJ, Baker Z, Chuang KW, Copp HL, Davidson J, Davis-Dao CA, Ewing E, Ko J, Lee V, Macaraeg A, Nicassio L, Sadighian M, Stephany HA, Sturm R, Swords K, Wang P, Wehbi EJ, Khoury AE. A multicenter study of acute testicular torsion in the time of COVID-19. J Pediatr Urol 2021; 17:478.e1-478.e6. [PMID: 33832873 PMCID: PMC7977032 DOI: 10.1016/j.jpurol.2021.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure. OBJECTIVE To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period. STUDY DESIGN Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression. RESULTS A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04). DISCUSSION We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group. CONCLUSIONS In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.
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Affiliation(s)
- Sarah A Holzman
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
| | - Jennifer J Ahn
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Zoe Baker
- Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kai-Wen Chuang
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Hillary L Copp
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Jacob Davidson
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Carol A Davis-Dao
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Emily Ewing
- Western University, Department of Urology, London, Ontario, Canada
| | - Joan Ko
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Victoria Lee
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Amanda Macaraeg
- University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Lauren Nicassio
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Michael Sadighian
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Heidi A Stephany
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Renea Sturm
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kelly Swords
- University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA
| | - Peter Wang
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Elias J Wehbi
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Antoine E Khoury
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
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Chest CT Profile of Non-COVID Pediatric Patients During the Pandemic. Indian J Pediatr 2021; 88:835. [PMID: 34036545 PMCID: PMC8149263 DOI: 10.1007/s12098-021-03803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 11/06/2022]
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Feketea G, Vlacha V, Tsiros G, Voila P, Pop RM, Bocsan IC, Stanciu LA, Zdrenghea M. Vitamin D Levels in Asymptomatic Children and Adolescents with Atopy during the COVID-19 Era. J Pers Med 2021; 11:jpm11080712. [PMID: 34442356 PMCID: PMC8400733 DOI: 10.3390/jpm11080712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
This study assessed vitamin D status in asymptomatic children and adolescents in Greece, with and without atopy, and possible changes during the coronavirus disease 2019 (COVID-19) pandemic. Serum levels of 25-hydroxy-vitamin D (25(OH)D) and total immunoglobulin E (IgE), and eosinophil count were measured in 340 asymptomatic children and adolescents (155 males, 185 females), mean age 8.6 ± 4.6 years, recruited over a period of 24 months (February 2019–January 2021). Atopy, defined by high level of IgE for age, was associated with vitamin D deficient status (p = 0.041). Subjects with and without atopy showed similar rates of insufficient and normal levels of 25(OH)D. The median level of 25(OH)D was significantly higher in subjects recruited during the pandemic, when home confinement rules were observed, than before the pandemic, and significantly more children had normal levels of 25(OH)D (p < 0.001), but no differences were noticed for IgE levels or eosinophil count. These results support a link between vitamin D and allergic and infectious inflammations, and specifically the association of vitamin D deficiency with asymptomatic atopy, defined as increased IgE level for age.
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Affiliation(s)
- Gavriela Feketea
- Department of Haematology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (M.Z.)
- Hospital Unit of Amaliada, Department of Paediatrics, 27200 Amaliada, Greece
| | - Vasiliki Vlacha
- Department of Paediatrics, Karamandanio Children’s Hospital, 26331 Patras, Greece;
- Department of Early Years Learning and Care, University of Ioannina, 26331 Ioannina, Greece
| | - Georgios Tsiros
- Gastouni Health Centre, Department of Family Medicine, 27300 Gastouni, Greece;
| | - Panagiota Voila
- Private Medical Laboratory, Clinical Chemistry Department, 27200 Amaliada, Greece;
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
- Correspondence:
| | | | - Mihnea Zdrenghea
- Department of Haematology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (G.F.); (M.Z.)
- Ion Chiricuta Oncology Institute, Republicii Str., No. 34-36, 400010 Cluj-Napoca, Romania
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Geanacopoulos AT, Sundheim KM, Greco KF, Michelson KA, Parsons CR, Hron JD, Winn AS. Pediatric Intern Clinical Exposure During the COVID-19 Pandemic. Hosp Pediatr 2021; 11:e106-e110. [PMID: 33863816 PMCID: PMC8650022 DOI: 10.1542/hpeds.2021-005899] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric health care encounters declined during the coronavirus disease 2019 (COVID-19) pandemic, and pediatric residency programs have adapted trainee schedules to meet the needs of this changing clinical environment. We sought to evaluate the impact of the pandemic on pediatric interns' clinical exposure. METHODS In this retrospective cohort study, we quantified patient exposure among pediatric interns from a single large pediatric residency program at a freestanding children's hospital. Patient encounters and shifts per pediatric intern in the inpatient and emergency department settings were evaluated during the COVID-19 pandemic, from March to June 2020, as compared with these 3 months in 2019. Patient encounters by diagnosis were also evaluated. RESULTS The median number of patient encounters per intern per 2-week block declined on the pediatric hospital medicine service (37.5 vs 27.0; P < .001) and intensive care step-down unit (29.0 vs 18.8; P = .004) during the pandemic. No significant difference in emergency department encounters was observed (63.0 vs 40.5; P = .06). The median number of shifts worked per intern per 2-week block also decreased on the pediatric hospital medicine service (10.5 vs 9.5, P < .001). Across all settings, there were more encounters for screening for infectious disease and fewer encounters for respiratory illnesses. CONCLUSIONS Pediatric interns at the onset of the COVID-19 pandemic were exposed to fewer patients and had reduced clinical schedules. Careful consideration is needed to track and supplement missed clinical experiences during the pandemic.
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Affiliation(s)
| | | | | | - Kenneth A Michelson
- Department of Pediatrics
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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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.
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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
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Marron L, Burke S, Kavanagh P. The public health and health system implications of changes in the utilisation of acute hospital care in Ireland during the first wave of COVID-19: Lessons for recovery planning. HRB Open Res 2021; 4:67. [DOI: 10.12688/hrbopenres.13307.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. Methods: A retrospective, population-based, interrupted time-trend study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Results: Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). Discussion: While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.
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