Emergency Department Visits for Pediatric Infectious Conditions Decrease After COVID-19

Study Objective: Following the arrival of COVID-19 in the New York metropolitan area in March 2020, pediatric ED visits markedly decreased. Possible reasons for this include parental reluctance to bring their children to the ED due to fear of exposure and mandates to socially isolate (which may have also decreased infectious disease transmission) and increasing use of telemedicine. Our goal was to determine whether ED visits for some common pediatric infectious conditions changed following the arrival of COVID-19 in our area. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Of these, 5 hospitals had dedicated pediatric EDs. Hospitals were teaching or non-teaching and rural, suburban or urban. Annual ED volumes were from 12,000 to 122,000. Population: consecutive ED patients ≤ 18 years old between March 1 and November 30 in 2019 and 2020. Data analysis: We arbitrarily chose to examine the following conditions: otitis media, bronchiolitis, streptococcal pharyngitis, croup and diarrhea, identified by the International Classification of Diseases codes, version 10. We tallied total visits and visits for each of these diagnoses in 2019 and 2020 time periods. We report the percentage changes in visits from 2019 to 2020 along with their 95% confidence intervals (CIs). Results: The database contained 300,627 visits in 2019 and 2020. From 2019 to 2020, total visits decreased by 58%, from 211,018 in 2019 to 89,609 in 2020. Visits in 2019 and 2020 respectively, were: otitis media (7080, 1775);bronchiolitis (2041, 267);streptococcal pharyngitis (2813, 863);croup (2547, 389) and diarrhea (3533, 900). This represents the following decreases from 2019 to 2020: otitis media 75% (95% CI 73-76%), bronchiolitis 87% (95% CI 85-88%), streptococcal pharyngitis 69% (95% CI 67-71%), croup 85% (95% CI 83-86%) and diarrhea 74% (95% CI 73-76%). Conclusion: Total pediatric ED visits and visits for specific infectious conditions markedly decreased following the arrival of COVID-19 in our area. Further studies are needed to investigate the impact that the reduction in ED visits had on patient clinical outcomes.

91 Where Have All the Children Gone? The Effects of COVID-19 on Pediatric Emergency Department Visits

Study Objectives: Our syndromic surveillance system of patient chief complaints showed a marked rise in respiratory complaints on March 10th, 2020 as Covid19 arrived in our region. Subsequently, pediatric visits to the emergency department (ED) markedly decreased, likely due to recommendations for quarantine and fear of contracting the virus. Our goal was to determine the extent of decrease in ED visits for several common pediatric conditions for which parents normally would have sought emergency care. Methods: This was a retrospective cohort design. The setting was at the EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching or non-teaching and rural, suburban or urban;7 hospitals had separate pediatric EDs. Annual ED volumes of pediatric patients were from 3000 to 43,000. Population: Consecutive pediatric patients (age ≤ 21yrs) seen by ED physicians between January 1 and April 30 in 2019 and 2020. Data analysis: We chose to examine the monthly visits for the following using ICD-10 codes: anxiety, appendicitis, asthma, headaches, seizure, and urinary tract infection (UTI). We computed the changes in monthly visits for March and April from 2019 to 2020. We used chi-square to test for statistical significance. We set alpha at 0.002, using the Bonferroni correction for multiple comparisons. Results: Our database contained 222,302 total pediatric visits. Compared to 2019, total visits in January and February 2020 increased by 15% and 4%, respectively, but in March and April they decreased by 36% and 81%, respectively. Visits in March and April 2020, compared to the same months in 2019, decreased by 17% and 76%, respectively, for anxiety;by 29% and 34%;for appendicitis;by 40% and 91% for asthma;by 17% and 76% for headache;by 13%, and 60% for seizures;and by 46% and 79% for UTIs. All p-values for comparisons were statistically significant, p<0.002, except, in March, for seizures (p=0.25), appendicitis (p=0.007) and headache (p=0.02). Conclusion: We found a marked decrease in ED visits for several common pediatric conditions after COVID-19 arrived in our region. We suspect that this decrease was due to recommendations for quarantine during this pandemic as well as fear of exposure to COVID-19. Further studies are needed to determine if this has led to complications due to delay in seeking medical care.