Pediatric emergency care admissions for somatic symptom disorders during the COVID-19 pandemic.

During the COVID-19 pandemic, children and adolescents with psychiatric disorders experienced an exacerbation of their symptoms with more access to the emergency department (ED). However, little is known about the experience of somatic symptom disorders (SSDs) during the COVID-19 pandemic in children. Therefore, we aimed to compare the rates of pediatric ED admissions for SSDs before and during the COVID-19 pandemic and to understand whether the relative risk of ED admissions for SSDs changed between the two periods. We retrospectively enrolled all children between 4 and 14 years admitted for SSDs in the pediatric ED of Santobono-Pausilipon Hospital, Naples, Italy, from March 11th, 2020, to March 11th, 2021 (pandemic period), and in the same time period of the previous year (pre-pandemic period). We identified 205/95,743 (0,21%) children with SSDs presenting in ED in the pre-pandemic year and 160/40,165 (0,39%) in the pandemic year (p < 0.05). Considering the accesses for age, we observed a relative decrease of the accesses for SSDs over 12 years old (IRR 0,59; CI 0,39-0,88), while we found no differences under 12 years old (IRR 0,87; CI 0,68-1,10).   Conclusion: In this study, we found that despite the massive decrease in pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders' admissions to the pediatric ED increased, suggesting an impact of the pandemic also on pediatric psychiatric disorders. What is Known: • During the COVID -19 pandemic, children and adolescents with a psychiatric disorder experienced exacerbation of their symptoms with more accesses in Emergency Department. What is New: • We found that despite the massive decrease of the pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders admissions in healthy children to the pediatric Emergency Department increased ,suggesting an impact of the pandemic also on the pediatric psychiatric disorders.

Early recognition of multisystem inflammatory syndrome temporally associated to COVID-19 in the emergency department: A single tertiary care centre experience

Introduction: Multisystem Inflammatory Syndrome in Children (MISC) is a new and life-threatening disease temporally associated to Covid-19. Objectives: The aim of the study is to analyze the clinical, laboratoristic and instrumental features of patients with diagnosis of MIS-C at the onset in order to early recognize the disease. Methods: We retrospectively reviewed clinical records of children admitted to our Emergency Department between April 2020 and March 2021, who were ultimately diagnosed with MIS-C associated with SARS-CoV2. Data collected included all clinical and laboratory parameters at presentation to the Emergency Department. We also recorded data regarding the duration of fever and hospitalization and the presence of abnormalities at chest X-ray, abdominal and cardiac ultrasound. Results: Clinical and laboratory data of the twenty-seven children retrospectively enrolled, including symptoms at presentation to the Emergency Department, are summarized in Table 1. Median duration of fever was 4 days (range 1.5 - 7). With the exception of fever, abdominal pain and diarrhea were the most frequent complaints at presentation. No significant differences were found between laboratory parameters in children with or without abdominal pain, diarrhea, vomit, conjunctivitis or rash. Heart ultrasound showed no abnormalities in 11 out of 27 children (41%). Findings in other children were mainly represented by mild pericardial effusion (29.6%) and mild mitral valve insufficiency (25.9%). Minor abnormalities in the interventricular septal dynamics were detected in 3 subjects (11.1%). Abdominal ultrasound was unremarkable in 5 out of 27 patients (18.5%). Most children (51.8%) had mild-to-moderate peritoneal effusion, which was often associated with ileal loops wall thickening (29.6%). The thickened segments were mostly located in proximity of the ileo-cecal valve or of the appendix. Mesenteric lymphadenitis was found in eleven children (40.7%). No significant differences were found in clinical or laboratory parameters between children with abnormal heart or abdominal ultrasounds and those without pathologic findings at these exams. Chest X ray at presentation showed no significant abnormalities in most patients, and only the child who died one day after admission showed bilateral basal opacities. Conclusion: The collected data allow to identify clinical and laboratoristic tic elements of patients admitted to Emergency care unit to provide early recognition of the MIS-C .The study included a modest sample size and for this reason the generalizability of results is limited. A national multicentre study is ongoing.