Pediatric emergency department visits during the COVID-19 pandemic: a large retrospective population-based study

Abstract

Background: COVID-19 pandemic has stretched healthcare system capacities worldwide and deterred people from seeking medical support at Emergency Departments (ED). Nevertheless, population-based studies examining the consequences on children are lacking.

Methods: All ED visits from 2019 to 2020 in Veneto, Italy (4.9 million residents) were collected. Anonymized records of pediatric (≤14 years) ED visits included patient characteristics, arrival mode, triage code, clinical presentation, and discharge mode. Year-on-year variation of the main ED visit characteristics, and descriptive trends throughout the study period have been examined.

Results: Overall, 425,875 ED presentations were collected, 279,481 in 2019, and 146,394 in 2020 (- 48%), with a peak (- 79%) in March-April (first pandemic wave), and a second peak (below - 60%) in November-December (second pandemic wave). Burn or trauma, and fever were the two most common clinical presentations. Visits for nonurgent conditions underwent the strongest reduction during both pandemic waves, while urgent conditions reduced less sharply. ED arrival by ambulance was more common in 2020 (4.5%) than 2019 (3.5%), with a higher proportion of red triage codes (0.5%, and 0.4% respectively), and hospitalizations following ED discharge (9.1%, and 5.9% respectively).

Conclusion: Since the beginning of the COVID-19 pandemic, pediatric ED presentations underwent a steeper reduction than that observed for adults. Lockdown and fear of contagion in hospital-based services likely deterred parents from seeking medical support for their children. Given COVID-19 could become endemic, it is imperative that public health experts guarantee unhindered access to medical support for urgent, and less urgent health conditions, while minimizing infectious disease risks, to prevent children from suffering direct and indirect consequences of the pandemic.

Keywords: Access to healthcare services; COVID-19; Children; Emergency department; Pandemic.

Fig. 1

Pediatric emergency department visits (EDV) in Veneto (Italy) and the most significant governmental interventions, plotted against the number of hospitalized patients with COVID-19 symptoms, and daily incidence rate of SARS-CoV-2 infections, in 2020.* * y-axis 1 (left): frequency of pediatric EDVs; y-axis 2 (right): number of hospitalized patients with COVID-19 symptoms, and daily incidence rate of new SARS-CoV-2 infections

Fig. 2

Monthly year-on-year variation of triage color codes assigned to children in emergency departments in 2019 and 2020. Orange triage color codes introduced in 2020 were merged with yellow codes for consistency across the study period

Fig. 3

Bimestrial trend of the most common clinical presentations among children at emergency departments in 2019 and 2020 (N = 296,324 visits). Less frequent, unspecified and missing clinical presentations were excluded from this analysis (N = 129,551). *ENT disorders: Ear, Nose, and Throat disorders

Fig. 4

Trajectories of pediatric emergency department visits in 2019 and 2020 grouped by arrival mode, triage code, and outcome. All trajectories with missing data on arrival mode, triage color code, or discharge mode were excluded from the analyses (N = 4603). Visits with a white triage code (N = 232,010) were excluded to better appreciate the most relevant changes among the less frequent triage codes (i.e., red, yellow, and green tags). Orange triage color codes introduced in 2020 were merged with yellow codes for consistency across the study period