Reductions in hospital care among clinically vulnerable children aged 0–4 years during the COVID-19 pandemic

Abstract

To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic.

Design

Birth cohort.

Setting

National Health Service hospitals in England.

Study population

All children aged <5 years with a birth recorded in hospital administrative data (January 2010–March 2021).

Main exposure

Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks’ gestation) or low birth weight (<2500 g).

Main outcomes

Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020–2021).

Results

Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic.

Conclusion

One in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic.

SciScore for 10.1101/2021.12.16.21267904: (What is this?)

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

Table 1: Rigor

Ethics	not detected.
Sex as a biological variable	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	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:

Limitations include under-ascertainment of chronic conditions for children who could not be admitted to hospital due to the pandemic. These children may have been managed in primary care, or as outpatients, which does not reliably code chronic conditions. Our analyses may underestimate vulnerability for the 10% of children without a record of gestational age or birthweight as we assumed they had non-vulnerable status. Multiple imputation of missing data was not feasible given the study size. Second, we could not quantify the deficit in A&E attendances, as longitudinal linkage is not currently available. However, studies investigating A&E attendances have reported similar deficits to those found in our study.(22,23) Our modelling approach required several assumptions (including continued trends in hospital contacts), and the differences we report are likely conservative estimates of impact. Deficits in hospital care for children during the pandemic have been reported in Europe,(7,24–31) Asia,(32) North,(33–36) and South America.(37) Most studies investigated A&E attendances or unplanned admissions.(23–37) Other studies report a reduction in asthma-related paediatric emergency department attendances,(27) and reduced likelihood of admission, assessment and surgery for children with epilepsy.(38) Furthermore, significant reductions in infection-related hospitalisations have been observed,(28,32,34,39) particularly for children under 5 years.(39) Two studies conducted national lev...

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:

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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.

Results from scite Reference Check: We found no unreliable references.

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