Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study
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Published:2022-08-26
Issue:8
Volume:19
Page:e1003974
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ISSN:1549-1676
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Container-title:PLOS Medicine
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language:en
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Short-container-title:PLoS Med
Author:
Nijman Ruud G.ORCID, Honeyford KateORCID, Farrugia RuthORCID, Rose KatyORCID, Bognar ZsoltORCID, Buonsenso DaniloORCID, Da Dalt LivianaORCID, De TishamORCID, Maconochie Ian K.ORCID, Parri NiccoloORCID, Roland DamianORCID, Alfven TobiasORCID, Aupiais CamilleORCID, Barrett MichaelORCID, Basmaci Romain, Borensztajn DorineORCID, Castanhinha SusanaORCID, Vasilico CorinneORCID, Durnin SheenaORCID, Fitzpatrick Paddy, Fodor LaszloORCID, Gomez BorjaORCID, Greber-Platzer SusanneORCID, Guedj Romain, Hartshorn StuartORCID, Hey FlorianORCID, Jankauskaite LinaORCID, Kohlfuerst DanielaORCID, Kolnik MojcaORCID, Lyttle Mark D.ORCID, Mação Patrícia, Mascarenhas Maria Inês, Messahel ShroukORCID, Özkan Esra Akyüz, Pučuka ZandaORCID, Reis Sofia, Rybak AlexisORCID, Ryd Rinder MalinORCID, Teksam Ozlem, Turan CanerORCID, Thors Valtýr StefánssonORCID, Velasco RobertoORCID, Bressan Silvia, Moll Henriette A.ORCID, Oostenbrink RianneORCID, Titomanlio LuigiORCID,
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.
Funder
National Institute for Health Research
Publisher
Public Library of Science (PLoS)
Reference73 articles.
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