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01-07-2021 | SARS-CoV-2 | Original Article

The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

Authors: Matthijs D. Kruizinga, Daphne Peeters, Mirjam van Veen, Marlies van Houten, Jantien Wieringa, Jeroen G. Noordzij, Jolita Bekhof, Gerdien Tramper-Stranders, Nienke J. Vet, Gertjan J. A. Driessen

Published in: European Journal of Pediatrics | Issue 7/2021

Abstract

The coronavirus disease 2019 pandemic has enormous impact on society and healthcare. Countries imposed lockdowns, which were followed by a reduction in care utilization. The aims of this study were to quantify the effects of lockdown on pediatric care in the Netherlands, to elucidate the cause of the observed reduction in pediatric emergency department (ED) visits and hospital admissions, and to summarize the literature regarding the effects of lockdown on pediatric care worldwide. ED visits and hospital admission data of 8 general hospitals in the Netherlands between January 2016 and June 2020 were summarized per diagnosis group (communicable infections, noncommunicable infections, (probable) infection-related, and noninfectious). The effects of lockdown were quantified with a linear mixed effects model. A literature review regarding the effect of lockdowns on pediatric clinical care was performed. In total, 126,198 ED visits and 47,648 admissions were registered in the study period. The estimated reduction in general pediatric care was 59% and 56% for ED visits and admissions, respectively. The largest reduction was observed for communicable infections (ED visits: 76%; admissions: 77%), whereas the reduction in noninfectious diagnoses was smaller (ED visits 36%; admissions: 37%). Similar reductions were reported worldwide, with decreases of 30–89% for ED visits and 19–73% for admissions.

Conclusion: Pediatric ED utilization and hospitalization during lockdown were decreased in the Netherlands and other countries, which can largely be attributed to a decrease in communicable infectious diseases. Care utilization for other conditions was decreased as well, which may indicate that care avoidance during a pandemic is significant.

What is Known: • The COVID-19 pandemic had enormous impact on society. • Countries imposed lockdowns to curb transmission rates, which were followed by a reduction in care utilization worldwide.
What is New: • The Dutch lockdown caused a significant decrease in pediatric ED utilization and hospitalization, especially in ED visits and hospital admissions because of infections that were not caused by SARS-CoV-2. • Care utilization for noninfectious diagnoses was decreased as well, which may indicate that pediatric care avoidance during a pandemic is significant.

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World Health Organization. Coronavirus disease 2019 (COVID-19). Situation Report – 51. Published March 11 2020

Alfano V, Ercolano S (2020) The efficacy of lockdown against COVID-19: a cross-country panel analysis. Appl Health Econ Health Policy 18(4):509–517. https://doi.org/10.1007/s40258-020-00596-3CrossRefPubMedPubMedCentral

News items on Coronavirus COVID-19 by the Government of the Netherlands. Retrieved from https://www.government.nl/topics/coronavirus-covid-19/news

Thelot B, Bourrillon A (1996) Coincidence of public transport strike with bronchiolitis epidemic. Lancet 348(9043):1743–1744. https://doi.org/10.1016/S0140-6736(05)65879-5CrossRefPubMed

Hasegawa K, Tsugawa Y, Cohen A, Camargo CA Jr (2015) Infectious disease-related emergency department visits among children in the US. Pediatr Infect Dis J 34(7):681–685. https://doi.org/10.1097/INF.0000000000000704CrossRefPubMedPubMedCentral

Isba R, Edge R, Jenner R, Broughton E, Francis N, Butler J (2020) Where have all the children gone? Decreases in paediatric emergency department attendances at the start of the COVID-19 pandemic of 2020. Arch Dis Child. https://doi.org/10.1136/archdischild-2020-319385

Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G (2020) Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 4(5):e10–e11. https://doi.org/10.1016/s2352-4642(20)30108-5CrossRefPubMedPubMedCentral

Friedrich F, Ongaratto R, Scotta MC, Veras TN, Stein R, Lumertz MS, Jones MH, Comaru T, Pinto LA (2020) Early Impact of social distancing in response to COVID-19 on hospitalizations for acute bronchiolitis in infants in Brazil. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa1458

Snapiri O, Rosenberg Danziger C, Krause I, Kravarusic D, Yulevich A, Balla U, Bilavsky E (2020) Delayed diagnosis of paediatric appendicitis during the COVID-19 pandemic. Acta Paediatr Int J Paediatr 109(8):1672–1676. https://doi.org/10.1111/apa.15376CrossRef

10.

Catassi GN, Vallorani M, Cerioni F, Lionetti E, Catassi C (2020) A negative fallout of COVID-19 lockdown in Italy: life-threatening delay in the diagnosis of celiac disease. Dig Liver Dis 52(10):1092–1093. https://doi.org/10.1016/j.dld.2020.05.016CrossRefPubMedPubMedCentral

11.

Chiaravalli S, Ferrari A, Sironi G, Gattuso G, Bergamaschi L, Puma N, Schiavello E, Biassoni V, Podda M, Meazza C, Spreafico F, Casanova M, Terenziani M, Luksch R, Massimino M (2020) A collateral effect of the COVID-19 pandemic: delayed diagnosis in pediatric solid tumors. Pediatr Blood Cancer:e28640. https://doi.org/10.1002/pbc.28640

12.

Brandenberger J, Bozorgmehr K, Vogt F, Tylleskar T, Ritz N (2020) Preventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients. Int J Equity Health 19(1):58. https://doi.org/10.1186/s12939-020-01172-wCrossRefPubMedPubMedCentral

13.

Hale T, Angrist N, Cameron-Blake E, Hallas L, Kira B, Majumdar S, Petherick A, Phillips T, Tatlow H, Webster S (2020) Oxford COVID-19 government response tracker, Blavatnik School of Government.Accessed February 19, 2021. https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker

14.

Clavenna A, Nardelli S, Sala D, Fontana M, Biondi A, Bonati M (2020) Impact of COVID-19 on the pattern of access to a pediatric emergency department in the Lombardy Region, Italy. Pediatr Emerg Care 36:e597–e598. https://doi.org/10.1097/pec.0000000000002232CrossRefPubMed

15.

Masetti R, Corsini I, Leardini D, Lanari M, Pession A (2020) Presentations to the emergency department in Bologna, Italy, during COVID-19 outbreak. BMJ Paediatr Open 4 (1). https://doi.org/10.1136/bmjpo-2020-000748

16.

Valitutti F, Zenzeri L, Mauro A, Pacifico R, Borrelli M, Muzzica S, Boccia G, Tipo V, Vajro P (2020) Effect of population lockdown on pediatric emergency room demands in the era of COVID-19. Front Pediatr 8. https://doi.org/10.3389/fped.2020.00521

17.

Scaramuzza A, Tagliaferri F, Bonetti L, Soliani M, Morotti F, Bellone S, Cavalli C, Rabbone I (2020) Changing admission patterns in paediatric emergency departments during the COVID-19 pandemic. Arch Dis Child. https://doi.org/10.1136/archdischild-2020-319397

18.

Cozzi G, Zanchi C, Giangreco M, Rabach I, Calligaris L, Giorgi R, Conte M, Moressa V, Delise A, Poropat F (2020) The impact of the COVID-19 lockdown in Italy on a pediatric emergency setting. Acta Paediatr 109:2157–2159. https://doi.org/10.1111/apa.15454CrossRefPubMed

19.

Manzoni P, Militello MA, Fiorica L, Cappiello AR, Manzionna M (2020) Impact of COVID-19 epidemics in paediatric morbidity and utilisation of Hospital Paediatric Services in Italy. Acta Paediatr. https://doi.org/10.1111/apa.15435

20.

Ciacchini B, Tonioli F, Marciano C, Faticato MG, Borali E, Pini Prato A, Felici E (2020) Reluctance to seek pediatric care during the COVID-19 pandemic and the risks of delayed diagnosis. Ital J Pediatr 46(1):87. https://doi.org/10.1186/s13052-020-00849-wCrossRefPubMedPubMedCentral

21.

Vierucci F, Bacci C, Mucaria C, Dini F, Federico G, Maielli M, Vaccaro A (2020) How COVID-19 pandemic changed children and adolescents use of the emergency department: the experience of a secondary care pediatric unit in Central Italy. SN Compr Clin Med 2:1959–1969. https://doi.org/10.1007/s42399-020-00532-5CrossRefPubMedPubMedCentral

22.

Ciofi Degli Atti ML, Campana A, Muda AO, Concato C, Ravà L, Ricotta L, Reale A, Barbieri M, D'Argenio P, Lancella L, Villani A, Raponi M (2020) Facing SARS-CoV-2 pandemic at a COVID-19 Regional Children’s Hospital in Italy. Pediatr Infect Dis J 39:e221–e225. https://doi.org/10.1097/inf.0000000000002811CrossRefPubMed

23.

Iozzi L, Brambilla I, Foiadelli T, Marseglia GL, Ciprandi G (2020) Paediatric emergency department visits fell by more than 70% during the COVID-19 lockdown in Northern Italy. Acta Paediatr Int J Paediatr 109:2137–2138. https://doi.org/10.1111/apa.15458CrossRef

24.

Agostoni C, Bertolozzi G, Cantoni B, Colombo C, Montini G, Marchisio P (2020) Three months of COVID-19 in a pediatric setting in the center of Milan. Pediatr Res. https://doi.org/10.1038/s41390-020-01108-8

25.

Dean P, Zhang Y, Frey M, Shah A, Edmunds K, Boyd S, Schwartz H, Frey T, Stalets E, Schaffzin J, Vukovic AA, Reeves S, Masur T, Kerrey B (2020) The impact of public health interventions on critical illness in the pediatric emergency department during the SARS-CoV-2 pandemic

26.

Even L, Lipshaw MJ, Wilson PM, Dean P, Kerrey BT, Vukovic AA (2020) Pediatric emergency department volumes and throughput during the COVID-19 pandemic

27.

Westgard BC, Morgan MW, Vazquez-Benitez G, Erickson LO, Zwank MD (2020) An analysis of changes in emergency department visits after a state declaration during the time of COVID-19. Ann Emerg Med 76:595–601. https://doi.org/10.1016/j.annemergmed.2020.06.019CrossRefPubMedPubMedCentral

28.

Chaiyachati BH, Agawu A, Zorc JJ, Balamuth F (2020) Trends in pediatric emergency department utilization after institution of COVID-19 mandatory social distancing. J Pediatr 226:274–277.e1. https://doi.org/10.1016/j.jpeds.2020.07.048CrossRefPubMedCentralPubMed

29.

Hartford EA, Keilman A, Yoshida H, Migita R, Chang T, Enriquez B, Liu DR (2020) Pediatric emergency department responses to COVID-19: transitioning from surge preparation to regional support. Disaster Med Public Health Prep:1-14. https://doi.org/10.1017/dmp.2020.197

30.

Kenyon CC, Hill DA, Henrickson SE, Bryant-Stephens TC, Zorc JJ (2020) Initial effects of the COVID-19 pandemic on pediatric asthma emergency department utilization. J Allergy Clin Immunol Pract 8:2774–2776.e1. https://doi.org/10.1016/j.jaip.2020.05.045CrossRefPubMedPubMedCentral

31.

Hassoun A, Pugh S, Merced I, Sharma M (2020) The power of social isolation on pediatric emergency visits during COVID-19 lockdown. Acta Paediatr 109:2425–2426. https://doi.org/10.1111/apa.15490CrossRefPubMed

32.

Walker DM, Tolentino VR (2020) COVID-19: the effects on the practice of pediatric emergency medicine. Pediatr Emerg Med Pract 17(3):1–15PubMed

33.

Kuitunen I, Artama M, Mäkelä L, Backman K, Heiskanen-Kosma T, Renko M (2020) Effect of social distancing due to the COVID-19 pandemic on the incidence of viral respiratory tract infections in children in Finland during early 2020. Pediatr Infect Dis J 39:e423–e427. https://doi.org/10.1097/inf.0000000000002845CrossRefPubMed

34.

Ferrero F, Ossorio MF, Torres FA, Debaisi G (2020) Impact of the COVID-19 pandemic in the paediatric emergency department attendances in Argentina. Arch Dis Child 106:e5. https://doi.org/10.1136/archdischild-2020-319833CrossRefPubMed

35.

Molina Gutiérrez MÁ, Ruiz Domínguez JA, Bueno Barriocanal M, de Miguel LB, López López R, Martín Sánchez J, de Ceano-Vivas la Calle M (2020) Impact of the COVID-19 pandemic on emergency department: early findings from a hospital in Madrid. An Pediatr 93:313–322. https://doi.org/10.1016/j.anpedi.2020.06.021CrossRef

36.

Dann L, Fitzsimons J, Gorman KM, Gorman KM, Hourihane J, Hourihane J, Okafor I (2020) Disappearing act: COVID-19 and paediatric emergency department attendances. Arch Dis Child 105:810–811. https://doi.org/10.1136/archdischild-2020-319654CrossRefPubMed

37.

Dopfer C, Wetzke M, Zychlinsky Scharff A, Mueller F, Dressler F, Baumann U, Sasse M, Hansen G, Jablonka A, Happle C (2020) COVID-19 related reduction in pediatric emergency healthcare utilization - a concerning trend. BMC Pediatr 20(1):427. https://doi.org/10.1186/s12887-020-02303-6CrossRefPubMedPubMedCentral

38.

McDonnell T, Nicholson E, Conlon C, Barrett M, Cummins F, Hensey C, McAuliffe E (2020) Assessing the impact of COVID-19 public health stages on paediatric emergency attendance. Int J Environ Res Public Health 17(18):1–25. https://doi.org/10.3390/ijerph17186719CrossRef

39.

Hartnett KP, Kite-Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, Gundlapalli AV (2020) Impact of the COVID-19 Pandemic on Emergency Department Visits - United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep 69(23):699–704. https://doi.org/10.15585/mmwr.mm6923e1CrossRefPubMedPubMedCentral

40.

Angoulvant F, Ouldali N, Yang DD, Filser M, Gajdos V, Rybak A, Guedj R, Soussan-Banini V, Basmaci R, Lefevre-Utile A, Brun-Ney D, Beaujouan L, Skurnik D (2020) COVID-19 pandemic: impact caused by school closure and national lockdown on pediatric visits and admissions for viral and non-viral infections, a time series analysis. Clin Infect Dis 72:319–322. https://doi.org/10.1093/cid/ciaa710CrossRef

41.

Akuaake LM, Hendrikse C, Spittal G, Evans K, Van Hoving DJ (2020) Cross-sectional study of paediatric case mix presenting to an emergency centre in Cape Town, South Africa, during COVID-19. BMJ Paediatr Open 4 (1). https://doi.org/10.1136/bmjpo-2020-000801

42.

Krivec U, Kofol Seliger A, Tursic J (2020) COVID-19 lockdown dropped the rate of paediatric asthma admissions. Arch Dis Child 105:809–810. https://doi.org/10.1136/archdischild-2020-319522CrossRefPubMed

43.

Polcwiartek LB, Polcwiartek C, Andersen MP, Ostergaard L, Broccia MD, Gislason GH, Kober L, Torp-Pedersen C, Schou M, Fosbol E, Kragholm K, Hagstrom S (2021) Consequences of coronavirus disease-2019 (COVID-19) lockdown on infection-related hospitalizations among the pediatric population in Denmark. Eur J Pediatr. https://doi.org/10.1007/s00431-021-03934-2

44.

Malhotra C, Chaudhry I, Ozdemir S, Finkelstein EA Reduced health-care utilization among people with chronic medical conditions during coronavirus disease 2019. Proceedings of Singapore Healthcare 0 (0):2010105820964533. https://doi.org/10.1177/2010105820964533

45.

Jansen D, Illy KE (2020) Delayed presentation to regular Dutch paediatric care in COVID-19 times: a national survey. BMJ Paediatr Open 4(1):e000834. https://doi.org/10.1136/bmjpo-2020-000834CrossRefPubMedPubMedCentral

46.

Goldman RD, Grafstein E, Barclay N, Irvine MA, Portales-Casamar E (2020) Paediatric patients seen in 18 emergency departments during the COVID-19 pandemic. Emerg Med J 37(12):773–777. https://doi.org/10.1136/emermed-2020-210273CrossRefPubMed

47.

Dayal D, Gupta S, Raithatha D, Jayashree M (2020) Missing during COVID-19 lockdown: children with onset of type 1 diabetes. Acta Paediatr Int J Paediatr 109(10):2144–2146. https://doi.org/10.1111/apa.15443CrossRef

48.

Kubicek K, Liu D, Beaudin C, Supan J, Weiss G, Lu Y, Kipke MD (2012) A profile of nonurgent emergency department use in an urban pediatric hospital. Pediatr Emerg Care 28(10):977–984. https://doi.org/10.1097/PEC.0b013e31826c9aabCrossRefPubMedPubMedCentral

49.

Taquechel K, Diwadkar AR, Sayed S, Dudley JW, Grundmeier RW, Kenyon CC, Henrickson SE, Himes BE, Hill DA (2020) pediatric asthma health care utilization, viral testing, and air pollution changes during the COVID-19 pandemic. J Allergy Clin Immunol Pract. https://doi.org/10.1016/j.jaip.2020.07.057

50.

Białynicki-Birula R, Siemasz I, Otlewska A, Matusiak Ł, Szepietowski JC (2020) Influence of COVID-19 pandemic on hospitalizations at the tertiary dermatology department in south-west Poland. Dermatol Ther 33:e13738. https://doi.org/10.1111/dth.13738CrossRefPubMed

51.

Haripersad YV, Kannegiesser-Bailey M, Morton K, Skeldon S, Shipton N, Edwards K, Newton R, Newell A, Stevenson PG, Martin AC (2020) Outbreak of anorexia nervosa admissions during the COVID-19 pandemic. Arch Dis Child 106:e15. https://doi.org/10.1136/archdischild-2020-319868CrossRefPubMed

52.

Cheek JA, Craig SS, West A, Lewena S, Hiscock H (2020) Emergency department utilisation by vulnerable paediatric populations during COVID-19 pandemic. Emerg Med Australas 32:870–871. https://doi.org/10.1111/1742-6723.13598CrossRefPubMed

53.

Schaffert M, Zimmermann F, Bauer L, Kastner S, Schwarz A, Strenger V, Metzger R, Thun-Hohenstein L, Sperl W, Weghuber D, Wortmann SB, additional individual contributors as listed in the s (2020) Austrian study shows that delays in accessing acute paediatric healthcare outweighed the risks of COVID-19

54.

Hughes HE, Hughes TC, Morbey R, Challen K, Oliver I, Smith GE, Elliot AJ (2020) Emergency department use during COVID-19 as described by syndromic surveillance. Emerg Med J 37:600–604. https://doi.org/10.1136/emermed-2020-209980CrossRefPubMed

55.

Mekaoui N, Razine R, Bassat Q, Benjelloun BS, Karboubi L (2020) The effect of COVID-19 on paediatric emergencies and admissions in Morocco: cannot see the forest for the trees?

Title: The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature
Authors: Matthijs D. Kruizinga
Daphne Peeters
Mirjam van Veen
Marlies van Houten
Jantien Wieringa
Jeroen G. Noordzij
Jolita Bekhof
Gerdien Tramper-Stranders
Nienke J. Vet
Gertjan J. A. Driessen
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keywords: SARS-CoV-2
COVID-19
Pediatrics
Published in: European Journal of Pediatrics / Issue 7/2021
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-021-04015-0

2024 ASCO Annual Meeting

Springer Medicine

The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

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