The coronavirus disease 2019 (COVID-19) pandemic, attributable to the explosive spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), almost paralyzed the world. Healthcare didn’t escape this effect, with emergency department (ED) visits showing a steep decline because the fear of contracting the infection grew.

Study: Presentations of kids to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study. Image Credit: Alex Yeung/Shutterstock

Background

A recent study reported on the occurrence of this decrease in ED visits amongst children with acute illness or injury, using an observational design across several countries. The aim was to define this phenomenon in addition to to try to discover the danger aspects and effects.

Introduction

As sanitary cordons, contact tracing, and quarantine and isolation measures, were put into operation to stem the pace of transmission of the virus during its earliest catastrophic phase. Accordingly, hospitals and other medical facilities often cancel or postpone elective or non-urgent visits and procedures.

Concerns were raised as to how this might affect morbidity and mortality attributable to less serious but more chronic illnesses. It was feared that patients might present later and at a more serious stage of illness attributable to the restrictions in force. Some sporadic evidence suggested that diabetic ketoacidosis (DKA) was presenting more commonly amongst children on the ED, in addition to intussusception and other acute illnesses, seemingly bearing out this fear.

Within the absence of a giant, multicenter study, the present study, published within the journal PLoS Medicine, sought to look at how pandemic-related lockdowns impacted ED visits amongst children in 16 European countries. As a part of the “Epidemiology, severity and outcomes of kids presenting to emergency departments across Europe through the SARS-CoV-2 pandemic” (EPISODES) study, it covered a period between January 2018 and May 2020, comparing the incidence and sort of pediatric ED visits with those within the two years immediately preceding this era. 

The study was designed to be a retrospective observational study, using routine clinical data from 38 centers.

What did the study show?

The findings of the present study revealed a general and widespread reduction in ED visits and hospital admissions across all of the study sites and all pediatric age groups. The autumn was proportional to the severity of the pandemic when it comes to COVID-19 prevalence within the region of interest and the stringency of containment measures implemented. Actually, when 4 or more measures were in force, the numbers plummeted by almost 90% in comparison with regions with no containment measures.

At worst, only 5% of ED visits in comparison with preceding years was recorded, at one site, while at best, the number was down by 46%. Overall, ED attendance was sustained at half the anticipated levels, or more, in France, Sweden, Ireland, Iceland, Latvia, and the Netherlands.

Hospitals that catered only to children showed lower reductions in ED visits, with those serving each adult and pediatric patients showing 3.5-fold lower numbers of patients in comparison with the previous. Urban hospitals also showed the identical trend in comparison with urban-rural hospitals.

When visits were categorized by cause, essentially the most affected were infectious disease visits, which remained significantly lower throughout the study period. This included tonsillitis, otitis media, gastrointestinal infections, and lower respiratory tract infections (LRTIs). Common minor injuries in children, including those to the pinnacle and breaks within the radius, were decreased as well.

Contrary to common perception, there was no increase in DKA, intussusception, or testicular torsion, even when COVID-19 prevalence was high, in absolute numbers. Mental health issues were less commonly observed but increased from the top of March, together with minor injuries, though not minor childhood illnesses.

ED visits were greater than twice as high in regions with lower prevalence, and infants were relatively more prone to be brought in than the following oldest age groups, in some sites at the least. That’s, children aged 1-2 years registered a 14% decrease in ED presentations, vs. 20% and 30% in those between 2-5 years and kids above this age but below 18, respectively. Nevertheless, these differences were less marked than those between countries.

Pediatric intensive care admissions were also affected, showing a fall of 30%, but lower than general admissions. When the urgency of triage was used as a sorting criterion, the variety of patients assigned to lower urgency triage was reduced essentially the most, though numbers in emergent and really urgent triage categories were also halved.

Conclusions

The study reflected a reduced pediatric attendance at EDs throughout Europe through the period of the primary lockdown related to the COVID-19 pandemic. This fall partially spared seriously unwell or injured children, though the numbers of such cases presenting on the ED fell relative to pre-pandemic levels. Less urgent cases, comparable to minor injuries and customary infections, showed the best and most sustained reduction.

The explanations may very well be many, including a bent not to hunt care by the parents, changes in healthcare access, and the reduced spread of respiratory pathogens attributable to infection control measures.

“The findings suggest that the introduction of infection prevention measures can decrease the burden of acute childhood illnesses and injuries.” The absence of unsupervised interactions between children, reduced air pollution, and higher compliance with medication, could all have contributed to a lower incidence of infections in addition to potentially dangerous activities, accounting for the lower variety of such cases.  

Interestingly, illnesses comparable to mental health crises or diabetic ketoacidosis made up a bigger proportion of ED visits amongst children. This might have led to a improper assumption that these events were occurring at the next rate than was the case. Conversely, it may very well be driven by the greater deal with mental health issues through the pandemic.

Furthermore, urgent intervention continued to be required in the identical variety of cases, making it mandatory to take care of surgical teams for emergency surgery even during such health crises.

Our study informs how pediatric emergency medicine can prepare for future pandemics, taking into consideration that different infectious diseases outbreaks can affect children otherwise, and illustrates the potential of electronic health records to observe trends in urgent and emergency care for youngsters.”