In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 19, No. 8 ( 2022-8-26), p. e1003974-
Abstract:
During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Methods and findings Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p 〈 0.001) and in children aged 〈 12 months (12 to 〈 24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to 〈 5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to 〈 12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age 〈 12 months as reference group, p 〈 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p 〈 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p 〈 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. Conclusions Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. Trial registration ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258 .
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003974
DOI:
10.1371/journal.pmed.1003974.g001
DOI:
10.1371/journal.pmed.1003974.g002
DOI:
10.1371/journal.pmed.1003974.g003
DOI:
10.1371/journal.pmed.1003974.g004
DOI:
10.1371/journal.pmed.1003974.g005
DOI:
10.1371/journal.pmed.1003974.g006
DOI:
10.1371/journal.pmed.1003974.t001
DOI:
10.1371/journal.pmed.1003974.t002
DOI:
10.1371/journal.pmed.1003974.t003
DOI:
10.1371/journal.pmed.1003974.s001
DOI:
10.1371/journal.pmed.1003974.s002
DOI:
10.1371/journal.pmed.1003974.s003
DOI:
10.1371/journal.pmed.1003974.s004
DOI:
10.1371/journal.pmed.1003974.s005
DOI:
10.1371/journal.pmed.1003974.s006
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10.1371/journal.pmed.1003974.s007
DOI:
10.1371/journal.pmed.1003974.s008
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10.1371/journal.pmed.1003974.s009
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10.1371/journal.pmed.1003974.s010
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10.1371/journal.pmed.1003974.s011
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10.1371/journal.pmed.1003974.s012
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10.1371/journal.pmed.1003974.s013
DOI:
10.1371/journal.pmed.1003974.s014
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10.1371/journal.pmed.1003974.s015
DOI:
10.1371/journal.pmed.1003974.s016
DOI:
10.1371/journal.pmed.1003974.s017
DOI:
10.1371/journal.pmed.1003974.s018
DOI:
10.1371/journal.pmed.1003974.s019
DOI:
10.1371/journal.pmed.1003974.s020
DOI:
10.1371/journal.pmed.1003974.s021
DOI:
10.1371/journal.pmed.1003974.s022
DOI:
10.1371/journal.pmed.1003974.r001
DOI:
10.1371/journal.pmed.1003974.r002
DOI:
10.1371/journal.pmed.1003974.r003
DOI:
10.1371/journal.pmed.1003974.r004
DOI:
10.1371/journal.pmed.1003974.r005
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2164823-2
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