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1.
Health Promot Chronic Dis Prev Can ; 40(11-12): 336-341, 2020 12 09.
Article in English, French | MEDLINE | ID: covidwho-1022346

ABSTRACT

INTRODUCTION: Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. METHODS: Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. RESULTS: The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. CONCLUSION: As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.


Subject(s)
/epidemiology , Emergency Service, Hospital/statistics & numerical data , Wounds and Injuries/epidemiology , Accidents, Traffic/statistics & numerical data , Adolescent , Athletic Injuries/epidemiology , Child , Child, Preschool , Female , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Protective Factors , Quebec/epidemiology , Wounds and Injuries/etiology
2.
Pediatr Emerg Care ; 37(1): 48-53, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1006320

ABSTRACT

OBJECTIVE: We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States. METHODS: We conducted a prospective multicenter survey of PED medical director(s) from selected children's hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children's hospitals were identified for recruitment through an established national research network. RESULTS: We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non-COVID-19 patients, 60% had COVID-19-dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%). CONCLUSIONS: This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.


Subject(s)
/epidemiology , Disaster Planning , Emergency Service, Hospital/organization & administration , Health Care Surveys , Pandemics , Personnel, Hospital/education , Child , Cross-Sectional Studies , Disaster Planning/statistics & numerical data , Education, Distance , Emergency Service, Hospital/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Humans , Personal Protective Equipment , Prospective Studies , Simulation Training , Telecommunications , Triage , United States
3.
Emerg Med J ; 37(12): 773-777, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-894883

ABSTRACT

BACKGROUND: Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year. METHODS: We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year. RESULTS: A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively). CONCLUSION: Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.


Subject(s)
Coronavirus Infections/epidemiology , Emergency Medicine/organization & administration , Emergency Service, Hospital/organization & administration , Hospitals, Pediatric/organization & administration , Pneumonia, Viral/epidemiology , Adolescent , Betacoronavirus/pathogenicity , British Columbia/epidemiology , Child , Child, Preschool , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Emergencies/epidemiology , Emergency Medicine/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Pandemics/prevention & control , Patient Admission/statistics & numerical data , Patient Discharge/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Triage/organization & administration , Triage/statistics & numerical data
5.
Ital J Pediatr ; 46(1): 155, 2020 Oct 16.
Article in English | MEDLINE | ID: covidwho-874035

ABSTRACT

BACKGROUND: The aim of this study was to quantify the impact of coronavirus disease 2019 (COVID-19) on pediatric operations, and establish preoperative, intraoperative, and postoperative protocols to improve the pediatric operations. METHODS: We here compare the number of patients who underwent surgery in Chongqing Medical University Affiliated Children's Hospital during the pandemic (January 23-March 11), after the pandemic (March 12-April 30), after our measures were put in place (May 1-May 21), and the equivalent period in 2019. RESULT: During the COVID-19 pandemic, 62.68% fewer patients underwent surgery than during the homologous period of time 1 year earlier (P < 0.01). After the COVID-19 pandemic, the number of orchidopexy cases increased significantly from 175.14 to 504.57 per week (P < 0.01). The large number of patients that accrued in our hospital may have increased the risk of COVID-19 transmission. In response, hospitals and clinics have made protocols and reorganized healthcare facilities (e.g., performing nucleic acid tests (NAT), adding adequate personal protective equipment (PPE)) from May 1, 2020. After the measures were implemented, the number of operations performed remained stable and comparable to the pre-pandemic period. COVID-19 RNA detection was performed in 5104 cases and there were no new confirmed cases in our hospital. CONCLUSION: This outbreak of COVID-19 has affected not only individuals with COVID-19 but also patients seeking surgical operations. Understanding the present situation helps clinicians provide a high level of treatment to all children.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hospitals, Pediatric/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Surgical Procedures, Operative/statistics & numerical data , Child , China/epidemiology , Comorbidity , Humans , Retrospective Studies
6.
BMC Infect Dis ; 20(1): 132, 2020 Feb 12.
Article in English | MEDLINE | ID: covidwho-827577

ABSTRACT

BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality. Its disease burden varies by age and etiology and is time dependent. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization. METHODS: We conducted a retrospective study in 30,994 children (aged 0-18 years) with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified as macrolide-sensitive MP, macrolide-less effective MP (MLEP), and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests. RESULTS: MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.4% of the total MP pneumonia. In children < 2 years of age, RSV (34.0%) was the most common cause of CAP, followed by MP (9.4%); however, MP was the most common cause of CAP in children aged 2-18 years of age (45.3%). Systemic corticosteroid was most commonly administered for MP pneumonia. The rate of hospitalization in intensive care units was the highest for RSV pneumonia, and ventilator care was most commonly needed in cases of adenovirus pneumonia. CONCLUSIONS: The present study provides fundamental data to establish public health policies to decrease the disease burden due to CAP and improve pediatric health.


Subject(s)
Community-Acquired Infections/etiology , Pneumonia, Mycoplasma/epidemiology , Pneumonia, Viral/epidemiology , Respiratory Syncytial Virus Infections/epidemiology , Adenoviridae Infections/drug therapy , Adenoviridae Infections/epidemiology , Adenoviridae Infections/etiology , Adolescent , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Female , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric/statistics & numerical data , Macrolides/therapeutic use , Male , Pneumonia, Mycoplasma/drug therapy , Pneumonia, Mycoplasma/etiology , Pneumonia, Viral/drug therapy , Pneumonia, Viral/etiology , Republic of Korea/epidemiology , Respiratory Syncytial Virus Infections/drug therapy , Respiratory Syncytial Virus Infections/etiology , Respiratory Syncytial Virus, Human/pathogenicity , Retrospective Studies , Seasons
7.
Emerg Med Australas ; 32(6): 1046-1051, 2020 12.
Article in English | MEDLINE | ID: covidwho-780657

ABSTRACT

OBJECTIVE: To estimate the personal protective equipment (PPE) required in a paediatric ED during the COVID-19 pandemic comparing the use per patient to use per patient zone, based on the NSW Clinical Excellence Commission (CEC) guidelines in place at the time of the study. METHODS: A retrospective case note review of all patients and staff present in the ED of The Children's Hospital at Westmead, Sydney, Australia in the 24 h period of Sunday 5 April 2020. The primary outcome of PPE estimates was generated from identifying the number of patient contacts and aerosol generating procedures (AGPs) performed per patient as well as the number of staff on shift. RESULTS: One hundred patients attended the ED (50% of usual) and all were included in the study. For a low-risk community environment allocating PPE per patient contact required 48 face shields, 382 surgical masks, 48 N95 masks and 430 gowns for the day, increasing to 430 face shields, 331 surgical masks, 430 N95 masks and 761 gowns in a high-risk community environment. Allocating PPE using zoning reduces the requirement to 48 face shields, 192 surgical masks, 48 N95 masks and 204 gowns, increasing to 196 face shields, 96 surgical masks, 196 N95 masks and 292 gowns per day in a high-risk community environment. CONCLUSION: This study has demonstrated the considerable requirement for PPE in a paediatric ED, which varies according to presentation type and the background prevalence of COVID-19 in the community.


Subject(s)
Coronavirus Infections/prevention & control , Emergency Service, Hospital/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Pandemics/prevention & control , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/prevention & control , Child , Child, Preschool , Coronavirus Infections/epidemiology , Female , Humans , Infant , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Needs Assessment , New South Wales/epidemiology , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/epidemiology , Retrospective Studies
8.
Euro Surveill ; 25(25)2020 06.
Article in English | MEDLINE | ID: covidwho-621605

ABSTRACT

Sentinel surveillance of acute hospitalisations in response to infectious disease emergencies such as the 2009 influenza A(H1N1)pdm09 pandemic is well described, but recognition of its potential to supplement routine public health surveillance and provide scalability for emergency responses has been limited. We summarise the achievements of two national paediatric hospital surveillance networks relevant to vaccine programmes and emerging infectious diseases in Canada (Canadian Immunization Monitoring Program Active; IMPACT from 1991) and Australia (Paediatric Active Enhanced Disease Surveillance; PAEDS from 2007) and discuss opportunities and challenges in applying their model to other contexts. Both networks were established to enhance capacity to measure vaccine preventable disease burden, vaccine programme impact, and safety, with their scope occasionally being increased with emerging infectious diseases' surveillance. Their active surveillance has increased data accuracy and utility for syndromic conditions (e.g. encephalitis), pathogen-specific diseases (e.g. pertussis, rotavirus, influenza), and adverse events following immunisation (e.g. febrile seizure), enabled correlation of biological specimens with clinical context and supported responses to emerging infections (e.g. pandemic influenza, parechovirus, COVID-19). The demonstrated long-term value of continuous, rather than incident-related, operation of these networks in strengthening routine surveillance, bridging research gaps, and providing scalable public health response, supports their applicability to other countries.


Subject(s)
Hospitals, Pediatric/statistics & numerical data , Immunization Programs/standards , Patient Admission/statistics & numerical data , Population Surveillance/methods , Vaccination/adverse effects , Vaccines/administration & dosage , Australia/epidemiology , Canada/epidemiology , Child , Child, Preschool , Data Accuracy , Health Policy , Hospitalization/statistics & numerical data , Humans , National Health Programs/standards , Public Health Surveillance , Vaccination/statistics & numerical data
9.
Pan Afr Med J ; 36: 162, 2020.
Article in French | MEDLINE | ID: covidwho-750419

ABSTRACT

Introduction: the purpose of our study was to assess the impact of COVID-19 on health care activities and prescriptions at the Albert Royer National Children´s Hospital in Dakar, Senegal. Methods: we conducted a retrospective, descriptive and analytical study comparing outpatient activity, hospitalizations and prescriptions over the first-quarter of 2019 and 2020. Results: an average drop in external consultations of 33% was reported in the first quarter of 2020 (the pandemic period) compared to the first quarter of 2019. An increase in hospitalizations was observed mainly in the months of January and February. However, a drop of 11% was reported in the month of March. The same is true for prescriptions, for which a drop of 10% was reported only in the month of March.Conclusion: the current COVID-19 pandemic has a significant impact on outpatients´ consultations, health care activities and prescriptions at the Albert Royer National Children´s Hospital. Effective measures should be taken to prevent effects on mortality and Hospital activities.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care/statistics & numerical data , Hospitalization/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Pneumonia, Viral/epidemiology , Child , Humans , Pandemics , Retrospective Studies , Senegal/epidemiology
10.
J Pediatr ; 224: 146-149, 2020 09.
Article in English | MEDLINE | ID: covidwho-724908

ABSTRACT

The lower than expected rates of children affected by coronavirus disease-2019 does not mean that there was no impact on children's health. Using data on pediatric healthcare visits before and after the breakout of coronavirus disease-2019 and historical data, we identified pediatric conditions that were most affected by the pandemic and epidemic control measures during the pandemic.


Subject(s)
Child Health/statistics & numerical data , Coronavirus Infections/epidemiology , Hospitals, Pediatric/statistics & numerical data , Pneumonia, Viral/epidemiology , Betacoronavirus , Child , China/epidemiology , Humans , Pandemics
11.
Hepatology ; 72(5): 1522-1527, 2020 11.
Article in English | MEDLINE | ID: covidwho-718329

ABSTRACT

BACKGROUND AND AIMS: A newly recognized multisystem inflammatory syndrome in children (MIS-C) has had a paradigm-shifting effect on the perception of severe acute respiratory syndrome, coronavirus-2 (SARS-CoV-2) illness severity in children. We report the clinical and biochemical features of liver involvement, and the comorbidities that present with hepatitis, in a substantial cohort of patients. APPROACH AND RESULTS: This is a retrospective cohort study of 44 patients with MIS-C admitted at Morgan Stanley Children's Hospital of New York-Presbyterian during April and May 2020. We evaluated the number of patients who developed hepatitis and examined both demographics and inflammatory laboratory values to ascertain those that were at higher risk for liver involvement and more severe disease. Hepatitis was present in 19 subjects (43%) and was associated with more severe disease. Persons with hepatitis had significantly higher rates of shock at presentation (21.1% vs. 0%; P = 0.008), greater respiratory support requirement (42.1% vs. 12%; P = 0.005), and longer hospitalization times (median, 7 [interquartile range {IQR}, 5, 10] vs. 4 days [IQR, 3.5, 6.5]; P < 0.05). Patients with hepatitis also had significantly higher levels of ferritin (706.9 vs. 334.2 mg/mL; P < 0.01), interleukin-6 (233.9 vs. 174.7 pg/mL; P < 0.05), troponin (83.0 vs. 28.5 ng/L; P < 0.05), and B-type natriuretic peptide (7,424.5 vs. 3,209.5 pg/mL; P < 0.05). The single patient with liver failure also developed multiorgan failure requiring vasopressors, hemodialysis, and mechanical ventilation. All patients were discharged, though >50% had persistent hepatitis up to 1 month after discharge. CONCLUSIONS: Hepatitis is common in children with MIS-C and is associated with a more severe presentation and persistent elevation of liver function tests in many. Despite the positive outcomes reported here, close follow-up is warranted given the limited knowledge of the long-term impact of SARS-CoV-2 on the liver.


Subject(s)
Coronavirus Infections/epidemiology , Hepatitis/epidemiology , Hospital Mortality/trends , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Systemic Inflammatory Response Syndrome/epidemiology , Acute Disease , Adolescent , Child , Child, Preschool , Cohort Studies , Coronavirus Infections/prevention & control , Female , Hepatitis/diagnosis , Hospitals, Pediatric/statistics & numerical data , Humans , Incidence , Liver Function Tests , Male , New York City , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Retrospective Studies , Risk Assessment , Severity of Illness Index , Statistics, Nonparametric , Systemic Inflammatory Response Syndrome/diagnosis
13.
Pediatr Infect Dis J ; 39(9): e221-e225, 2020 09.
Article in English | MEDLINE | ID: covidwho-636869

ABSTRACT

BACKGROUND: In Italy, the response to coronavirus disease 2019 (COVID-19) pandemic upgraded from social distancing on February 23, 2020, to national lockdown on March 11, 2020. We described how the pandemic affected a tertiary care children hospital with a dedicated COVID-19 regional center. METHODS: We analyzed the characteristics of emergency department (ED) visits, urgent hospitalizations and severe acute respiratory syndrome (SARS)-COV-2 reverse transcription-polymerase chain reaction testing, and COVID-19 patients across 3 response phases: before the first Italian case, before national lockdown and during lockdown. RESULTS: ED visits decreased from a daily mean of 239.1 before the first COVID-19 Italian case, to 79.6 during lockdown; urgent hospitalizations decreased from 30.6 to 21.2. As of April 20, 2020, 1970 persons were tested for SARS-CoV-2 reverse transcription-polymerase chain reaction and 2.6% were positive. Positive rates were 1.2% in the ED, 21.1% in the COVID center and 0.5% in other wards. The median age of COVID-19 patients (N = 33) was 6.7 years, 27% had coexisting conditions and 79% were related to family clusters. CONCLUSIONS: The pandemic strongly impacted on the use of hospital services, with a 67% reduction in ED visits and a 31% reduction in urgent hospitalizations. Separating the flows of suspected patients from all other patients, and centralization of suspected and confirmed cases in the COVID center enabled to control the risk of nosocomial SARS-CoV-2 transmission. Delay in hospital use for urgent care must be avoided, and clear communication on infection prevention and control must be provided to families. Further studies are needed to assess how the reduction in hospital use affected children healthcare needs during the pandemic.


Subject(s)
Civil Defense , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adolescent , Ambulatory Care , Betacoronavirus/isolation & purification , Child , Child, Preschool , Coronavirus Infections/therapy , Coronavirus Infections/virology , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Hospitals, Pediatric/organization & administration , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Italy/epidemiology , Male , Pandemics , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Tertiary Care Centers/organization & administration , Tertiary Care Centers/statistics & numerical data
14.
J Pediatr Surg ; 55(8): 1427-1430, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-548366

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, experience-based guidelines are needed in the pediatric population in order to deliver high quality care in a new way that keeps patients and healthcare workers safe and maximizes hospital resource utilization. BACKGROUND: The COVID-19 pandemic has created an unprecedented strain on national health care resources, particularly in New York City, the epicenter of the outbreak in the United States. Prudent allocation of surgical resources during the pandemic quickly became essential, and there is an unprecedented need to weigh the risks of operating versus delaying intervention in our pediatric patients. METHODS: Here we describe our experience in surgical decision-making in the pediatric surgical population at Morgan Stanley Children's Hospital of New York-Presbyterian (MSCHONY), which has served as a major urban catchment area for COVID-19 positive pediatric patients. We describe how we have adjusted our current treatment of multiple facets of pediatric surgery including oncology, trauma, minimally invasive procedures, and extracorporeal membrane oxygenation (ECMO). CONCLUSIONS: Our pediatric surgery department had to creatively and expeditiously adjust our protocols, guidelines, and workforce to not only serve our pediatric population but merge ourselves with our adult hospital system during the COVID pandemic. TYPE OF STUDY: Clinical research paper LEVEL OF EVIDENCE: Level V.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Decision Making , Guidelines as Topic , Hospitals, Pediatric/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Surgical Procedures, Operative/standards , Child , Humans , New York City/epidemiology
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