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. 2021 Mar 15;5(1):e000967.
doi: 10.1136/bmjpo-2020-000967. eCollection 2021.

Changing patterns of emergency paediatric presentations during the first wave of COVID-19: learning for the second wave from a UK tertiary emergency department

Dhurgshaarna Shanmugavadivel  1   2 , Jo-Fen Liu  3 , Colin Gilhooley  2   4 , Loai Elsaadany  5 , Damian Wood  5
Affiliations

Changing patterns of emergency paediatric presentations during the first wave of COVID-19: learning for the second wave from a UK tertiary emergency department

Dhurgshaarna Shanmugavadivel et al. BMJ Paediatr Open. .

Abstract

Background: The SARS-CoV-2 pandemic and initial public health response led to significant changes in health service delivery, access and utilisation. However, SARS-CoV-2 illness burden in children and young people (CYP) is low. To inform effective child public health interventions, we aimed to compare patterns of paediatric emergency department presentation during the initial pandemic response with a previous non-pandemic period.

Methods: Retrospective review of attendances (0-18 years) over the initial pandemic (2 March 2020-3 May 2020) compared with 2019. Outcome measures included number of attendances, referral source, presenting complaint, discharge diagnosis and disposal. Descriptive statistics with subgroup analysis by age/sex/ethnicity and pandemic time periods (pre-lockdown, lockdown weeks 1-3 and lockdown weeks 4-6) was performed.

Results: 4417 attendances (57% illness and 43% injuries) occurred, compared with 8813 (57% illness and 43% injuries), a reduction of 50%, maximal in lockdown week 2 (-73%). Ranking of top three illness presentations changed across the pandemic weeks. Breathing difficulty dropped from first (300, 25%) to second (117, 21%) to third (59, 11%) (p<0.001). Abdominal pain rose from the third pre-lockdown (87, 7%) and lockdown weeks 1-3 (37, 7%) to second in weeks 4-6 (62, 12%; p=0.004). Fever ranked second (235, 19%) in pre-lockdown and first in weeks 1-3 (134, 24%) and weeks 4-6 (94, 18%; p=0.035).

Conclusions: Despite a 50% reduction, there was no significant change in acuity of illness. Rank of illness presentations changed, with abdominal pain ranking second and fever first, an important change from previous, which should prompt further research into causes. CYP-specific public health messaging and guidance for primary care are required in this second wave to ensure access to appropriate emergency services.

Keywords: COVID-19; epidemiology; health services research.

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Conflict of interest statement

Competing interests: There are no competing interests.

Figures

Figure 1
Figure 1
Percentage change in attendances over a 9-week pandemic period compared with the same period in 2019.
Figure 2
Figure 2
Illness and injury presentations during the 2020 lockdown period and corresponding period in 2019. (A) Proportions of illness and injury by lockdown periods. (B) Proportions of illness presentations by week. (C) Proportions of injury presentations by week. (D) Change in absolute numbers and proportions of top three illness presentations by lockdown period. Shaded areas indicate national lockdown period (2 March–3 May 2020).
Figure 3
Figure 3
Proportions of admissions and discharges by weeks compared with the same period in 2019. (A) Admissions. (B) Discharges. Shaded areas indicate national lockdown period (2 March–3 May 2020).
See this image and copyright information in PMC

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