Pediatric Emergency Department Visits in US Hospitals Across 2019 and 2020

ABSTRACT

Background: This research leverages Clinical Emergency Data Registry (CEDR) data collected from 2019 to 2020. Developed by ACEP, CEDR is the first Emergency Medicine (EM) specialty-wide registry to measure acute care quality, outcomes, practice patterns, and trends in emergency care. ACEP began CEDR in 2015 focusing on quantifying and enhancing quality of emergency care through collection of quality data and development of EM-specific quality metrics. CEDR has collected data for 50 million visits representing 30 million unique patients. Study Objectives: Early in the pandemic, impact on emergency departments (ED) was substantial. By May, ED visits declined nearly 40%. CDC data indicated ED visits for patients younger than 14 declined by 70%. While several studies evaluated pandemic impact on pediatric cases, most focused on children’s hospitals or particular illnesses. This research assesses the impact on pediatric visits to all US EDs over the more extended timeline of the pandemic, including total visits, visits for influenza, and visits for COVID-19. Methods: The database was queried for visit data on patients 18 years and younger from January 2019 to December 2020. Visits were counted, not individuals, so two visits by the same individual count as two visits. Percentage of visits in this cohort with a diagnosis of influenza (ICD 10 Codes J09.X2, J10.-, J11.-) and COVID-19 (ICD 10 Code U07.1) were calculated. Data were compared to age-agnostic ED visits and percentage of visits for COVID-19 and influenza in the general public. This data was obtained from the National Syndromic Surveillance Program (NSSP), run by the CDC. NSSP received data from 93% of US hospitals and is provided to ACEP through an agreement with the CDC. It includes data on the number of ED visits and percentage of those visits made for COVID-19 and influenza. Simple descriptive analysis was used. Results: Pediatric ED visits experienced a 72% decline starting week 11 of 2020, coinciding with the WHO characterization of COVID-19 as a pandemic. Sharp decline continues for six weeks before plateauing. However, pediatric visits remain 38% below previous visit rates (Figure 1). General population ED visits decline significantly over an identical period, however, only decrease by 42%. These ED visits make a quicker recovery, returning to 88% of previous patient volume. When reviewing influenza and COVID-19 data, general public visits indicated a considerable lack of influenza cases during COVID-19 surges. Conversely, pediatric visits do not demonstrate the same surges. Instead, data showed repeated smaller COVID-19 spikes during the year. In addition, pediatrics did not reveal influenza suppression seen in the general public. Spiking in pediatric influenza was proportional to COVID-19 spikes, offset in time (Figure 2). Conclusion: This study reveals pediatric ED visits sharply decreased in early weeks of the pandemic. Recovery of ED visits is slower in pediatric populations compared to the general population. Further, percentage of visits for influenza and COVID-19 remain low in this population and do not show typical “waves” seen in the general population. The reduction in 2020 influenza cases seen in the adult population is not reflected in the pediatric population. Influenza spiked uniquely in the pediatric population throughout 2020. Isolation of children at home during the COVID-19 pandemic may account for limited vaccination resulting in equal exposure risks. [Formula presented] [Formula presented]