The impact of SARS on a tertiary care pediatric emergency department

Abstract

Background: The Greater Toronto Area (GTA) was considered a "hot zone" for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital.

Methods: We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000-2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest.

Results: Compared with the 2000-2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (p < 0.001) and increases in admission rates (p < 0.001) during the periods in 2003 when there were new and active cases of SARS in the GTA. All 3 outcomes returned to expected estimates coincident with the absence of SARS cases from September to December 2003.

Interpretation: During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.

Fig. 1: Cumulative numbers of probable SARS cases and deaths in Canada. Of the 251 probable cases in Canada, 245 occurred in the Greater Toronto Area (GTA), and 198 of those were in the city of Toronto (Dr. Bonnie, Toronto Public Health: personal communication, 2003).

Fig. 4: Length of stay in HSC emergency department for patients seen from Jan. 1 to Dec. 31, 2003 (SARS year), compared with those seen in 2000–2002 (non-SARS years).

Fig. 3: Hospital admission rates (per 100 visits to the HSC emergency department) from Jan. 1 to Dec. 31, 2003 (SARS year), compared with rates in 2001–2002 (non-SARS years).

Fig. 2: Number of patient visits per day to the Hospital for Sick Children (HSC) emergency department from Jan. 1 to Dec. 31, 2003 (SARS year), compared with number of visits in 2000–2002 (non-SARS years). Period 1 (Feb. 15 to Mar. 26) = only a few cases of SARS in GTA and relatively little public awareness. Period 2 (Mar. 27 to May 4) = strictest city-wide infection control measures in place and peak of SARS cases to initial containment of SARS on May 4. Period 3 (May 5 to June 12) = initial containment of SARS and second, smaller SARS cluster, which occurred during last 3 weeks of this period. Period 4 (June 13 to Sept. 15) = still active SARS cases but no new SARS cases, and continued SARS screening at HSC. Period 5 (Sept. 16 to Dec. 31) = no SARS cases in GTA.