Impact of COVID-19 on Pediatric Emergency Department Visits: A Retrospective Cohort Study

  1. Pierre Fontaine
  2. Esli Osmanlliu
  3. Jocelyn Gravel
  4. Ariane Boutin
  5. Evelyne D. Trottier
  6. Nathalie Orr Gaucher
  7. Antonio D’Angelo
  8. Olivier Drouin

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Abstract

Background & Objective

COVID-19 has caused significant shifts in healthcare utilization, including pediatric emergency departments (EDs). We describe variations in visits made to two large pediatric EDs during the first three months of the COVID-19 pandemic, compared to a historical control period.

Methods

We performed a retrospective cohort study of children presenting to two academic pediatric EDs in Quebec, Canada. We compared the number of ED visits during the first wave of COVID-19 pandemic (March-May 2020) to historical controls (March-May 2015-2019), using Poisson regression, adjusting for site and the underlying baseline trend. Secondary analyses examined variations in ED visits by acuity, disposition, and disease categories.

Results

From 2015 to 2019, the two EDs had a median of 1,632 visits per week [interquartile range (IQR) 1,548; 1,703]; in 2020, this number decreased to 536 visits per week [IQR 446; 744]. In multivariable analyses, this represent a 53.3% (95%CI: 52.1, 54.4) reduction in the number of ED visits. The reduction was larger among visits triage categories 4 and 5 (lower acuity) than categories 1, 2 and 3 (higher acuity): -54.2% vs. -42.0% (p<0.001). A greater proportion of children presenting to these sites were hospitalized during the COVID period than in pre-COVID period: 11.8% vs. 5.5% (p<0.001).

Conclusions

During the early stages of the COVID-19 pandemic, there was a large decrease in visits to pediatric EDs. Patients presented with higher acuity at triage and the proportion of patients requiring hospitalization increased.

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  1. ScreenIT

    SciScore for 10.1101/2021.04.05.21254921: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the ethics review board of CHUSJ on July 28th, 2020.
    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:
    Our findings need to be interpreted in light of a few limitations. First, data available for this analysis did not allow to disentangle the role and relative contribution of potential drivers of decreases in emergency visits. As such, whether there was really a delay in consultation and more severe presentations cannot be ascertained in this report. Second, our results represent visits at the two pediatric EDs in the province of Quebec and may therefore not be generalizable to other cities or countries, although the magnitude of change in ED visits is similar to other previously published studies. We were also limited to the information available in the electronic databases at each institution. For example, as the diagnostics were grouped into categories, it was not possible to tease out whether in a given category, there were increases in specific diagnoses. Finally, errors in the collection, entry and coding of data may occur, although errors in data should be evenly distributed between the two study periods.

    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 10.1101/2021.04.05.21254921v1 on medRxiv