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2.
Eur Respir J ; 2022 Nov 10.
Article in English | MEDLINE | ID: covidwho-2117205

ABSTRACT

BACKGROUND: Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of SARS-CoV-2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries. METHODS: We conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of the 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling. RESULTS: In total, 42 916 children were included. We observed an overall cumulative 78% reduction (95%CI [-100;-54], p<0.0001) in bronchiolitis cases following NPI implementation. The decrease varied between countries from -97% (95%CI [-100;-47], p=0.0005) to -36% (95%CI [-79;+07], p=0.105). Full lockdown (IRR 0.21, 95%CI [0.14;0.30], p<0.001), secondary-school closure (IRR 0.33, 95%CI [0.20;0.52], p<0.0001), wearing a mask indoors (IRR 0.49, 95%CI [0.25;0.94], p=0.034), and teleworking (IRR 0.55, 95%CI [0.31;0.97], p=0.038) were independently associated with reducing bronchiolitis. CONCLUSION: Several NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.

3.
Arch Dis Child ; 2022 Sep 26.
Article in English | MEDLINE | ID: covidwho-2053160

ABSTRACT

OBJECTIVE: To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING: Systematic review. DESIGN: Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS: Children under 18 years. INTERVENTIONS: National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES: Changes in paediatric emergency care utilisation. RESULTS: 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS: The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER: CRD42021242808.

4.
PLoS Med ; 19(8): e1003974, 2022 08.
Article in English | MEDLINE | ID: covidwho-2021500

ABSTRACT

BACKGROUND: 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.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Child , Communicable Disease Control , Emergency Service, Hospital , Europe/epidemiology , Humans , Retrospective Studies , SARS-CoV-2
5.
Archives of Disease in Childhood ; 107(Suppl 2):A14-A15, 2022.
Article in English | ProQuest Central | ID: covidwho-2019815

ABSTRACT

663 Figure 1[Figure omitted. See PDF] 663 Figure 2[Figure omitted. See PDF]ConclusionThis systematic review demonstrates that pandemics have significantly different impacts on paediatric emergency service utilisation depending on the epidemic/pandemic. Evidence from 80 papers that across the world demonstrates children’s attendances to Emergency Departments significantly fell during the COVID19 pandemic. The reasons for this are not entirely clear but are likely related to the public health response and parent/carer concern about the severity of the disease process.As public health messaging can impact on public behaviours, public health departments and related healthcare organisations must be aware how fear of viruses amongst the general public may influence their response to public health advice. There is inequality between low-middle and high income countries in reporting the impact of emergency service utilisation for children.

6.
Archives of Disease in Childhood ; 107(Suppl 2):A11-A12, 2022.
Article in English | ProQuest Central | ID: covidwho-2019814

ABSTRACT

AimsPaediatric emergency departments saw an unusual increased incidence and severity of disease presentation in children with new onset diabetes in the early phase of the COVID-19 pandemic. The DIMPLES study(Diabetes Mellitus in children and young people presenting to the Emergency Department during the SARS-CoV-2 pandemic) aimed to characterise the features of children presenting to Paediatric Emergency Department with new onset diabetes in the COVID-19 pandemic, exploring the incidence and severity of diabetic ketoacidosis (DKA).MethodsThe DIMPLES study is a retrospective multicentre study done across 49 paediatric emergency departments providing a unique perspective of new onset diabetes paediatric diabetes from the frontline.We compared the characteristics of children aged 6 months to 16 years presenting to the Paediatric Emergency Departments across UK and Ireland with new onset diabetes in the pandemic (March 1, 2020 to February 28, 2021) with the children presenting in the same time period over the pre pandemic period (March 1, 2019 to February 28, 2020).ResultsDuring the COVID pandemic year, there were increase from the pre-pandemic year in children with new onset diabetes presenting with DKA (pH <7.3;from 395 to 566;43% rise), severe DKA (pH <7.1;from 141 to 252;a 79% rise), and admissions to intensive care (from 38 to 72;89% rise), suggesting an increase in incidence and severity of new-onset diabetes. An increase in the incidence of new onset diabetes from 1015 to 1176 was noted in the pandemic(16% increase compared to an estimated increase of 2-4% per year).The median age of children who presented with new onset diabetes in the pandemic, the duration of symptoms before presentation and the ethnicity was similar to the pre pandemic period. Delay did not appear to be a significant factor in the pandemic compared to the pre pandemic period in the majority of cases.There was a paucity in testing for COVID-19 antibodies, 37/1176 children with new onset diabetes were tested with n=8 children testing positive for IgG/IgM COVID-19 antibodies. 12 children with new onset diabetes tested positive for SARS-CoV-2 on nasopharyngeal swabs, 7 presented with moderate to severe DKA and 3 presented with mild DKA.ConclusionThe DIMPLES study showed an increase in the number and severity of children presenting to the Paediatric Emergency Department with new onset diabetes and DKA in the COVID -19 pandemic. Proving association or causation was challenging given the small number of children tested for COVID-19 antibodies. When the incidence and severity at presentation is interpreted in the context of high levels of SARS-CoV-2 in the community and a low incidence of other viral infectious triggers it appears that COVID -19 may have a role as an accelerator or possibly even a precipitator of new onset diabetes in a genetically predisposed child.

8.
J Med Virol ; 94(11): 5547-5552, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1981876

ABSTRACT

Rhinoviruses have persisted throughout the COVID-19 pandemic, despite other seasonal respiratory viruses (influenza, parainfluenza, respiratory syncytial virus, adenoviruses, human metapneumovirus) being mostly suppressed by pandemic restrictions, such as masking and other forms of social distancing, especially during the national lockdown periods. Rhinoviruses, as nonenveloped viruses, are known to transmit effectively via the airborne and fomite route, which has allowed infection among children and adults to continue despite pandemic restrictions. Rhinoviruses are also known to cause and exacerbate acute wheezing episodes in children predisposed to this condition. Noninfectious causes such as air pollutants (PM2.5 , PM10 ) can also play a role. In this retrospective ecological study, we demonstrate the correlation between UK national sentinel rhinovirus surveillance, the level of airborne particulates, and the changing patterns of pediatric emergency department presentations for acute wheezing, before and during the COVID-19 pandemic (2018-2021) in a large UK teaching hospital.


Subject(s)
COVID-19 , Enterovirus Infections , Respiratory Syncytial Virus, Human , Respiratory Tract Infections , Adult , COVID-19/epidemiology , Child , Communicable Disease Control , Enterovirus Infections/epidemiology , Humans , Pandemics , Respiratory Sounds/etiology , Retrospective Studies , Rhinovirus
9.
Pediatr Res ; 2022 Apr 22.
Article in English | MEDLINE | ID: covidwho-1805591

ABSTRACT

BACKGROUND: We hypothesised that the clinical characteristics of hospitalised children and young people (CYP) with SARS-CoV-2 in the UK second wave (W2) would differ from the first wave (W1) due to the alpha variant (B.1.1.7), school reopening and relaxation of shielding. METHODS: Prospective multicentre observational cohort study of patients <19 years hospitalised in the UK with SARS-CoV-2 between 17/01/20 and 31/01/21. Clinical characteristics were compared between W1 and W2 (W1 = 17/01/20-31/07/20,W2 = 01/08/20-31/01/21). RESULTS: 2044 CYP < 19 years from 187 hospitals. 427/2044 (20.6%) with asymptomatic/incidental SARS-CoV-2 were excluded from main analysis. 16.0% (248/1548) of symptomatic CYP were admitted to critical care and 0.8% (12/1504) died. 5.6% (91/1617) of symptomatic CYP had Multisystem Inflammatory Syndrome in Children (MIS-C). After excluding CYP with MIS-C, patients in W2 had lower Paediatric Early Warning Scores (PEWS, composite vital sign score), lower antibiotic use and less respiratory and cardiovascular support than W1. The proportion of CYP admitted to critical care was unchanged. 58.0% (938/1617) of symptomatic CYP had no reported comorbidity. Patients without co-morbidities were younger (42.4%, 398/938, <1 year), had lower PEWS, shorter length of stay and less respiratory support. CONCLUSIONS: We found no evidence of increased disease severity in W2 vs W1. A large proportion of hospitalised CYP had no comorbidity. IMPACT: No evidence of increased severity of COVID-19 admissions amongst children and young people (CYP) in the second vs first wave in the UK, despite changes in variant, relaxation of shielding and return to face-to-face schooling. CYP with no comorbidities made up a significant proportion of those admitted. However, they had shorter length of stays and lower treatment requirements than CYP with comorbidities once those with MIS-C were excluded. At least 20% of CYP admitted in this cohort had asymptomatic/incidental SARS-CoV-2 infection. This paper was presented to SAGE to inform CYP vaccination policy in the UK.

10.
Children (Basel) ; 9(4)2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1776146

ABSTRACT

The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021-2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021-2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age.

11.
BMJ Paediatr Open ; 5(1)2021 12.
Article in English | MEDLINE | ID: covidwho-1769922

ABSTRACT

OBJECTIVE: Understanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave. DESIGN: This cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January-May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres. RESULTS: Overall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units (7%) increased their capacity. In 12 (31%) PEDs, they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs.There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.086). CONCLUSION: Overall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Adult , COVID-19/epidemiology , Child , Cross-Sectional Studies , Emergency Service, Hospital , Humans , SARS-CoV-2 , Surveys and Questionnaires
12.
Emergency Medicine Journal : EMJ ; 39(3):265, 2022.
Article in English | ProQuest Central | ID: covidwho-1702615

ABSTRACT

947 Table 1Moore’s Outcomes Framework Measure/Question Response LEVEL 1 Participation Participation in questionnaire 95 responses out of 851 staff. Have you seen the ED major Incident video in the Handover Room? 67% of respondents had seen the training video (90% of these watched the whole video). LEVEL 2 Satisfaction I was satisfied with the format, delivery and content of the video. 70% were satisfied with the format of the video I found the content of the video useful. 84% thought the content useful LEVEL 3A Learning: Declarative Knowledge I know how the ED is organised in a Major Incident. Before 25%, After 66%. LEVEL 3B Learning: Procedural Knowledge I know what to do in a major incident. Before 35%, After 67% I could locate the Major Incident tray in each area of the ED. Before 28%, After 53%. I would be able to perform well in a Major Incident. Before 40%, After increased to 69% Results/Conclusions64 of the respondents viewed the video. From the cohort, 70% were satisfied with the format of the video and 84% believed the content to be useful. Using the Moore’s outcome model there was an increase in 62.1% of the declarative knowledge post viewing, and a 47.8% increase in the confidence of knowing what to do in a MI. The confidence in being able to locate the MIP tray and perform well in a MI had also increased by 47.2% and 42.02% respectively.The repeated silent video format was an effective teaching tool, as reflected in all aspects of Moore’s model;majority of respondents showed improved confidence in all aspects of the MIP. Background training videos could form part of ED training, especially for topics which are not included in formal training programs.

14.
BMJ Paediatr Open ; 6(1)2022 02.
Article in English | MEDLINE | ID: covidwho-1685643

ABSTRACT

Paediatric emergency department (PED) attendances reduced worldwide during the COVID-19 pandemic (2020) but anecdotally babies under 30 days (BUD) appeared less affected. We collated monthly PED attendances (16 years and under) across four hospitals (three district general hospitals and a tertiary specialist PED) in England, UK from January 2017 to December 2020. Gross PED attendances dropped by 34% in 2020 (n=98 256) compared to 2019 (n=148 640). However, cumulative BUD attendances dropped by only 6% in 2020 (n=3922) compared to 2019 (n=4162). Monthly site-specific attendances showed marginal variation. PED attendances broadly decreased in 2020 with less of an impact on BUD.


Subject(s)
COVID-19 , COVID-19/epidemiology , Child , Emergency Service, Hospital , Hospitals , Humans , Infant , Pandemics , Retrospective Studies
15.
BMJ Paediatrics Open ; 5(Suppl 1):A50-A51, 2021.
Article in English | ProQuest Central | ID: covidwho-1476660

ABSTRACT

184 Table 1Comparison of number of PED presentation and hospital admissions of children with acute wheezing between January-March and April-June 2018 to 2020 2018 2019 2020 Difference in percentage* Total number of PED presentations with acute wheezing, n - January-March 507 671 557 −5% - April-June 427 697 84 −85% Total number of hospital admissions, n (%) - January-March 303 (60%) 430 (64%) 347 (62%) −5% - April-June 247 (58%) 436 (63%) 19 (23%) −95% PED presentations of children under 5, n - January-March 360 507 378 −13% - April-June 279 514 40 −90% Hospital admissions of children under 5, n (%) - January-March 241 (67%) 345 (68%) 256 (68%) −13% - April-June 173 (62%) 336 (65%) 10 (25%) −96% PED presentations of children over 5, n - January-March 147 164 179 +15% - April-June 148 183 44 −75% Hospital admissions of children over 5, n (%) - January-March 62 (42%) 85 (52%) 91 (51%) +24% - April-June 74 (50%) 100 (55%) 9 (20%) −90% *Difference in percentage is calculated by the difference between mean of 2018 and 2019 compared to 2020.ConclusionsStrict containment measures secondary to COVID-19 lockdown has had a positive impact in children with respiratory conditions. Whilst the current restrictions are not indefinitely sustainable, they demonstrate the potential health benefits of improved adherence to hand hygiene, pharmaceutical therapy, and sensible social distancing.

16.
Archives of Disease in Childhood ; 106(Suppl 1):A44, 2021.
Article in English | ProQuest Central | ID: covidwho-1443381

ABSTRACT

BackgroundSARS-CoV-2 infection presents significant challenges to the management of children. To our knowledge, the spread in healthcare settings between children had not been reported. Leicester was the first area in the United Kingdom to undergo a localised lockdown with reports of relatively high numbers of children affected.ObjectivesOur evaluation aimed to identify the number of clinically significant SARS-COV-2 paediatric patients (age < 18 years) presenting to our Children’s Emergency Department (CED) at the Leicester Royal Infirmary (LRI), investigate the effectiveness of infection control measures and examine outcomes.MethodsWe determined clinically significant infection to be that which prompted parents/carers to bring their child to the CED and be admitted. The national guidance in England at the time determined that only admitted patients are swabbed for SARS-COV-2.Clinical information on the timelines of hospital attendance, length of hospital stay (LOS) and outcomes was gathered by retrospectively from 15.03.2020 to 31.07.2020 by looking at the attendances in Nervecentre®.National infection control policies were followed, ranging from adoption of rigorous hand washing and provision of Personal Protective Equipment (PPE) for patient contacts, to the separation of the department into ‘red’ (suspected COVID) and ‘blue’ (non-suspected COVID) zones on the basis of pre-determined criteria.The study was ratified as a service evaluation project by the trust.Results27 children (0–15 years) tested COVID positive. 22 (81.5%) of these presented to the PED among 10777 presentations.20/22 (90.9%) patients were admitted, all were eventually discharged. Nearly all of the patients came through the red zone;21/22 (95.4%). The average Length of Stay (LOS) of these patients was 120.7 hours.2 patients were felt to have the novel Paediatric Inflammatory Multisystem Syndrome temporally related to SARS-CoV-2 (PIMS-TS), both needing paediatric intensive care stay. Children presented with lower respiratory tract infection (3/22;4/27), suspected sepsis (4/22;4/27), and Bronchiolitis (2/22;2/27).There was no overlap between any SARS-CoV-2 positive patients with any other patients who subsequently tested positive in the department. Thus, no clinically relevant SARS-CoV-2 cross-infection was noted.ConclusionsOur study demonstrated that children don’t appear to be causing spread within our CED. Division of CED into two areas meant a substantial change to our working due to changes in staff allocation and challenges to CED leadership. Only a very small number of patients were SARS-CoV-2 positive- this led us to believe that the existing measures to split the departments were effective, but also perhaps, unnecessary.On the basis of this study, the splitting of the CED into red and blue zones has been abolished and the department has been merged, to avail the staffing and space resources optimally to enhance patient safety and provide best healthcare services to our patients.This study could be crucial in anticipating and managing the future PED patient flow, especially during the winters when the other seasonal viral infections are likely to overburden the services.

18.
Wellcome Open Res ; 6: 120, 2021.
Article in English | MEDLINE | ID: covidwho-1378499

ABSTRACT

Background: Bronchiolitis (most frequently caused by respiratory syncytial virus; RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding capacity each winter. During the SARS-CoV-2 pandemic, the circulation of RSV was dramatically reduced in the United Kingdom and Ireland. Evidence from the Southern Hemisphere and other European countries suggests that as social distancing restrictions for SARS-CoV-2 are relaxed, RSV infection returns, causing delayed or even summer epidemics, with different age distributions. Study question: The ability to track, anticipate and respond to a surge in RSV cases is critical for planning acute care delivery. There is an urgent need to understand the onset of RSV spread at the earliest opportunity. This will influence service planning, to inform clinicians whether the population at risk is a wider age range than normal, and whether there are changes in disease severity. This information is also needed to inform decision on the timing of passive immunisation of children at higher risk of hospitalisation, intensive care admission or death with RSV infection, which is a public health priority. Methods and likely impact: This multi-centre prospective observational cohort study will use a well-established research network (Paediatric Emergency Research in the UK and Ireland, PERUKI) to report in real time cases of RSV infection in children aged under two years, through the collection of  essential, but non-identifying patient information. Forty-five centres will gather initial data on age, index of multiple deprivation quintile, clinical features on presentation, and co-morbidities. Each case will be followed up at seven days to identify treatment, viral diagnosis and outcome.  Information be released on a weekly basis and used to support clinical decision making.

19.
Health Expect ; 24(6): 2036-2046, 2021 12.
Article in English | MEDLINE | ID: covidwho-1360490

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the first UK lockdown (March to May 2020) witnessed a dramatic reduction in children presenting to primary/emergency care, creating concern that fear of the virus was resulting in children presenting late. METHODS: An online survey was co-developed with UK parents to understand the impact of the lockdown on parents' help-seeking for, and care of, their sick/injured child(ren). The survey was advertised through social media and snowballing to parents whose children had been ill/injured during the lockdown. Analysis used descriptive statistics, SPSSv25 and thematic analysis. RESULTS: The survey was fully completed by 198 UK parents. The majority asked for help (144/198): from their family doctor (78), national helplines (48) or an Emergency Department (23). Most reported that their decision-making had not changed, although how they sought help had changed. A few parents reported that the severity and duration of illness had increased because of uncertainty about and/or difficulty accessing services. Parents did not always report seeking help for symptoms rated red or amber by the Royal College of Paediatrics and Child Health. Parents reported accessing information through the internet or using information that they already had. PARENT CONTRIBUTION: This was a collaboration with parents from survey development to dissemination, with two parents being integral members of our research team. CONCLUSIONS: Our questionnaire was completed by parents who were not deterred from seeking help for their sick or injured children. Even for these parents, the lockdown changes to services created uncertainty about, and barriers to, accessing medical help for their children.


Subject(s)
COVID-19 , Pandemics , Child , Communicable Disease Control , Humans , Parents , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom
20.
Emerg Med Australas ; 33(5): 900-910, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294918

ABSTRACT

OBJECTIVES: The Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in paediatric emergency care to organise globally for the conduct of collaborative research across networks. METHODS: PERN has grown from five to eight member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children. RESULTS: Beginning as a pandemic response studying H1N1 influenza risk factors in children, PERN research has progressed to multiple observational studies and ongoing global randomised controlled trials (RCTs). As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current COVID-19 pandemic. CONCLUSIONS: Following its success with developing global research, the PERN goal now is to promote the implementation of scientific advances into everyday clinical practice by: (i) expanding the capacity for global RCTs; (ii) deepening the focus on implementation science; (iii) increasing attention to healthcare disparities; and (iv) expanding PERN's reach into resource-restricted regions. Through these actions, PERN aims to meet the needs of acutely ill and injured children throughout the world.


Subject(s)
COVID-19 , Emergency Medical Services , Child , Emergency Treatment , Health Services Research , Humans , SARS-CoV-2
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