Emergency Department Visits for Pediatric Infectious Conditions Decrease After COVID-19

ABSTRACT

Study Objective: Following the arrival of COVID-19 in the New York metropolitan area in March 2020, pediatric ED visits markedly decreased. Possible reasons for this include parental reluctance to bring their children to the ED due to fear of exposure and mandates to socially isolate (which may have also decreased infectious disease transmission) and increasing use of telemedicine. Our goal was to determine whether ED visits for some common pediatric infectious conditions changed following the arrival of COVID-19 in our area. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Of these, 5 hospitals had dedicated pediatric EDs. Hospitals were teaching or non-teaching and rural, suburban or urban. Annual ED volumes were from 12,000 to 122,000. Population consecutive ED patients ≤ 18 years old between March 1 and November 30 in 2019 and 2020. Data analysis: We arbitrarily chose to examine the following conditions otitis media, bronchiolitis, streptococcal pharyngitis, croup and diarrhea, identified by the International Classification of Diseases codes, version 10. We tallied total visits and visits for each of these diagnoses in 2019 and 2020 time periods. We report the percentage changes in visits from 2019 to 2020 along with their 95% confidence intervals (CIs). Results: The database contained 300,627 visits in 2019 and 2020. From 2019 to 2020, total visits decreased by 58%, from 211,018 in 2019 to 89,609 in 2020. Visits in 2019 and 2020 respectively, were otitis media (7080, 1775);bronchiolitis (2041, 267);streptococcal pharyngitis (2813, 863);croup (2547, 389) and diarrhea (3533, 900). This represents the following decreases from 2019 to 2020 otitis media 75% (95% CI 73-76%), bronchiolitis 87% (95% CI 85-88%), streptococcal pharyngitis 69% (95% CI 67-71%), croup 85% (95% CI 83-86%) and diarrhea 74% (95% CI 73-76%). Conclusion: Total pediatric ED visits and visits for specific infectious conditions markedly decreased following the arrival of COVID-19 in our area. Further studies are needed to investigate the impact that the reduction in ED visits had on patient clinical outcomes.