Changes in health-seeking behavior among adult and pediatric patients with seizures during the COVID-19 pandemic

ABSTRACT

Objective: To demonstrate any changes in seizure-related medical help-seeking behavior and admission outcomes during COVID-19. Background: The global outbreak of COVID-19 has imposed a huge challenge on healthcare systems globally. Infection control measures may have impacted patients' health-seeking behavior for non-respiratory conditions, particularly chronic diseases such as epilepsy. Design/Methods: All Accident & Emergency (A&E) attendances in Hong Kong for seizures in 2020 from January 23 to March 24 (adult) and April 22 (pediatric) were compared with parallel periods from 2015 to 2019. All data and admission outcomes were identified from a centralized territory-wide electronic database. Pre-existing time trend in control periods and changes during COVID-19 were analyzed by Poisson, negative and logistic regression models. Results: Among adults aged ≥ 18 years, seizure-related A&E attendances (adjusted relative risk, aRR 0.78, 95% CI=0.65 - 0.92, p=0.003) and admissions (aRR 0.70, 95% CI=0.60 - 0.80, p<0.001) decreased significantly during COVID-19. Ratio of ward admission per A&E attendance, intensive care utility and mortality rates remained stable. Among pediatric patients aged < 18 years, seizure-related attendances also decreased in 2020 (RR 0.38, 95% CI=0.25 - 0.59, p<0.001), with a disproportionate decrease in the 0-6 age group (RR 0.303, 95% CI=0.17 - 0.53, p<0.001). A drastic decline in upper respiratory infection-related A&E attendances (RR 0.208, 95% CI=0.14 - 0.31, p<0.001) was congruent to the time trends of seizure-related attendances in in the 0-6 age group. Conclusions: A significant reduction in emergency attendances for seizures during COVID-19 calls for appropriate measures to ensure healthcare services and education are provided to patients with epilepsy in a timely and effective manner during this global public health crisis. The congruent decrease in seizure- and URTI-related attendances among younger children suggests potential novel approaches focusing on infection control measures and immunization programs among younger children in prevention of febrile seizures and thus other related epileptic disorders in later life.