Paediatric Attendances and Acuity in the Emergency Department during the COVID-19 Pandemic

  1. Katy Rose
  2. Kerry Van-Zyl
  3. Rachel Cotton
  4. Susan Wallace
  5. Francesca Cleugh

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Abstract

Aim

To investigate the difference in both numbers and acuity of presentations to the Paediatric Emergency Department (PED) during the peak time period of the current global SARS-CoV-2 pandemic.

Design

This single centre retrospective observational study used routinely collected electronic health data to compare patient presentation characteristics between 21 st March and 26 th April 2020 compared to the equivalent time period in 2019.

Results

There was a 90% decrease in attendances to PED, with a 10.23% reduction re-attendance rate. Children presenting were younger during the pandemic, with a median age difference of 2 years. They were more likely to present in an ambulance (9.63%), be admitted to hospital (5.75%) and be assigned the highest two Manchester triage categories (6.26%). There was a non-significant trend towards longer lengths of stay. The top 10 presenting complaints remained constant (although the order changed) between time periods. There was no difference in mortality or admission to PICU.

Implications

Our data demonstrates that there has been a significant decrease in numbers of children seeking emergency department care. It suggests that presenting patients were proportionally sicker during the pandemic; however, we would argue that this is more in keeping with appropriate acuity for PED presentations, as there were no differences in PICU admission rate or mortality. We explore some of the possible reasons behind the decrease in presentations and the implications for service planning ahead of the winter months.

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    SciScore for 10.1101/2020.08.05.20168666: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitation on the spread of other infectious agents, coupled with a reduction in risk inherent activities (e.g. team sports and road use) will also have contributed. Parental use of 111 and online information may also have reduced unnecessary attendance. The need to understand these public health factors will become crucial to managing the busier winter period ahead; potentially preventable hospital attendances may be far greater than previously appreciated16. Our data supports the concern that, during the pandemic, children who present are sicker, but they are not in extremis. There were more children conveyed by ambulance and a higher proportion of PED attenders who were assigned higher overall triage categories. However, there was no difference in proportion at the highest “Red” triage category – defined as those who need care immediately. Reassuringly, death rates in the PED remained very low; no deaths occurred during the pandemic period. Additionally, direct admission to PICU was no different from 2019. We argue that changes in other acuity markers actually represent a more appropriate utilization of PED. Of interest was the proportion of unwell new-borns, a vulnerable population, presenting during the pandemic, 10.4%, when compared to 2019, 3.21%. Further work would be required to quantify the direct impact of reduced community services in the UK in response to the pandemic, which has been implicated to factor internationally for increased neonatal presentations 18. We...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.08.05.20168666v2 on medRxiv
  3. Version published to 10.1101/2020.08.05.20168666v1 on medRxiv