COVID-19 related reduction in pediatric emergency healthcare utilization - a concerning trend

Abstract

Background: The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization.

Methods: We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019.

Results: In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p < 0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs. 23.1% ±SEM 1.7 in 2020, p < 0.01) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p < 0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred.

Conclusions: Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.

Keywords: COVID-19; SARS-CoV-2; children; emergency care; emergency department; healthcare utilization; pandemic; pediatric.

Fig. 1

Reduced pediatric emergency healthcare utilization after the implementation of pandemic-related lockdown in Germany: A: daily number of visits between January 1st and April 19th 2019 (blue) vs. 2020 (red) including dates of COVID-19 related policy in Germany. B: visits per day in calendar weeks 12 to 15, C/D: visits per day within (C) and outside (D) ED daytime service in calendar weeks 12 to 15. E: increased proportion of daily visits of patients younger than one year (bars display mean + SEM (B-E) with overlaying dots representing single daily values, ** p ≤ 0.01, *** p ≤ 0.001)

Fig. 2

ED cases of patients presenting with noncommunicable disease as well as those with infectious disease or signs thereof were significantly reduced during the COVID-19 pandemic. A: daily number of visits between January 1st and April 19th 2019 (blue) vs. 2020 (red) by patients with noncommunicable diseases (A) and infectious diseases or signs thereof (B). C/D: reduced visits per day due to noncommunicable (C) or infectious diseases or typical signs thereof in calendar weeks 12 to 15. E: no change in the proportion of daily visits due to infectious diseases or typical signs thereof (bars display mean + SEM with overlaying dots representing single daily values (C-E), *** p ≤ 0.001)

Fig. 3

Distribution and frequency of ED presentation due to noncommunicable disease: A: proportion of organ system specific diagnoses in calendar weeks 12 to 15. B: daily number of visits per organ system specific disease entity in calendar weeks 12 to 15 (GIT: diseases/complaints of the gastrointestinal tract, intox.: intoxication, neuro: neurological diseases/complaints, neoplasm: neoplastic/malignant diseases/complaints, hematol.: hematological diseases/complaints, endocrinol.: endocrinological diseases/complaints, respir.: respiratory diseases/complaints, urogen.: urogenital diseases/complaints, psych.: psychiatric diseases/complaints ; bars display mean + SEM, * p ≤ 0.05, ** p ≤ 0.01, *** 0.001)

Fig. 4

Distribution and frequency of infectious disease after lockdown began: A: proportion of organ system specific diagnoses in calendar weeks 12 to 15. B: daily number of visits per organ system specific disease entity in calendar weeks 12 to 15 (respir.: respiratory infections, GIT: infections of the gastrointestinal tract, UTI.: urinary tract infections; bars display mean + SEM, ** p ≤ 0.01, *** 0.001)

Fig. 5

Frequency of hospital admission from our pediatric ED during pandemic-related lockdown: A: reduced numbers of daily hospitalisations in calendar weeks 12–15 in 2019 vs. 2020. B: increase in proportions of hospitalised patients per ED visit during the same periods, C: no difference in the duration of hospital stay D: distribution of diagnosis groups in hospitalised patients in 2019 vs. 2020 (GIT: diseases/complaints of the gastrointestinal tract, intox.: intoxication, respir.: respiratory diseases/complaints, bars display mean + SEM, ** p ≤ 0.01)