Equity in Paediatric Emergency Departments during COVID-19
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Abstract
Children’s attendances in paediatric emergency departments have fallen precipitously in North East England and elsewhere in recent months. We analysed data from 3 hospitals to understand which children were not being brought during the COVID-19 ‘lockdown’. In our population there is no evidence of a disproportionate impact on children belonging to vulnerable sociodemographic groups and no obvious change in illness acuity among those children still attending. However we noted a marked reduction in infectious disease presentations which might reflect one positive impact of enhanced social distancing on child health. More granular data describing the ‘collateral damage’ of the COVID-19 pandemic to children’s clinical services are needed to plan for the mitigation of its continuing effects.
What is known on this topic
Presentations to paediatric emergency departments in Europe and the United States have reduced dramatically during the COVID-19 pandemic ‘lockdown’.
What this paper adds box
This is the first paper to show that reduced attendance was proportionate across different deprivation and ethnicity groups.
We show that presentations of children with infectious diseases reduced more than those with other conditions or trauma.
There was no change in admission rates, taken as a broad indicator of illness acuity at presentation among the population still attending paediatric emergency departments.
Article activity feed
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SciScore for 10.1101/2020.09.25.20201533: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:A further limitation to interpretation is that around 1.5% of children from both DGHs were later referred or presented to the GNCH. Information-governance safeguards limited our ability to identify and remove these children …
SciScore for 10.1101/2020.09.25.20201533: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:A further limitation to interpretation is that around 1.5% of children from both DGHs were later referred or presented to the GNCH. Information-governance safeguards limited our ability to identify and remove these children from dual-analysis. Clinicians and policymakers might be reassured that whilst admissions are falling, there is no evidence at this early stage, in the North East of England, that particular groups of children have been specifically disadvantaged. There is early evidence that young children were brought for care at an appropriate point in their illness. However future studies might examine specific illnesses in more detail – for example, first presentations of diabetes mellitus type 1 where avoidance of delay is crucial. Given that social distancing measures are likely to continue for some time, our findings provide initial evidence for planning of emergency healthcare services to help mitigate the ‘collateral damage’ that the pandemic is causing to children. Further work to understand how parents rationalise healthcare seeking behaviour for their children during the pandemic is ongoing in our region (tinyurl.com/CoVID-northeast) and across the UK.
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.
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SciScore for 10.1101/2020.09.25.20201533: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
A further limitation to interpretation is that around 1.5% of children from both DGHs were later referred or presented to the GNCH. Information-governance safeguards limited our ability to identify and remove these children …
SciScore for 10.1101/2020.09.25.20201533: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
A further limitation to interpretation is that around 1.5% of children from both DGHs were later referred or presented to the GNCH. Information-governance safeguards limited our ability to identify and remove these children from dual-analysis. Clinicians and policymakers might be reassured that whilst admissions are falling, there is no evidence at this early stage, in the North East of England, that particular groups of children have been specifically disadvantaged. There is early evidence that young children were brought for care at an appropriate point in their illness. However future studies might examine specific illnesses in more detail – for example, first presentations of diabetes mellitus type 1 where avoidance of delay is crucial. Given that social distancing measures are likely to continue for some time, our findings provide initial evidence for planning of emergency healthcare services to help mitigate the ‘collateral damage’ that the pandemic is causing to children. Further work to understand how parents rationalise healthcare seeking behaviour for their children during the pandemic is ongoing in our region (tinyurl.com/CoVID-northeast) and across the UK.
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.
About SciScore
SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.
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