The impact of COVID-19 on the patterns of emergency department visits among pediatric patients.

OBJECTIVES: This study aimed to investigate the patterns of pediatric patients visiting emergency departments (EDs) before and after the COVID-19 pandemic and evaluate the interactive effect between the COVID-19 outbreak and age groups. METHODS: We performed a cross-sectional study using the nationwide emergency patient database in Korea from January 2019 to December 2020. Pediatric patients (≤18 years) who visited all 402 nationwide EDs were included. The age- and sex-standardized incidence rates of pediatric ED visits per 1,000,000 person-days were calculated, and the incidence rate ratio (IRR) was calculated. The adjusted odds ratio (aOR) and 95% confidence interval (CI) of in-hospital mortality were calculated by a multivariable logistic regression. RESULTS: Among 2,808,756 patients, 1,835,045 (65.3%) patients visited before COVID-19, and 973,711 (34.7%) patients visited after the COVID-19 period. The standardized incidence rates of ED visits per 1,000,000 person-days were 589.3 in the before COVID-19 group and 326.9 in the after COVID-19 group (IRR (95% CI): 0.55 (0.53-0.58)). By diagnosis, the IRRs (95% CI) of mental health disorders (0.84 (0.42-1.65)) and self-harm or suicidal attempts (0.99 (0.38-2.59) were not significant, while the incidence rate of infectious disease was significantly decreased (0.48 (0.42-0.54)). The aOR (95% CI) of in-hospital mortality after COVID-19 was 1.58 (1.44-1.73) compared to that before COVID-19. CONCLUSIONS: During the COVID-19 pandemic, the incidence of pediatric ED visits decreased, and these effects differed by age group. Age-specific policies are needed to ensure that children receive the care they need at the right time.

Changes in Clinical Characteristics among Febrile Patients Visiting the Emergency Department before and after the COVID-19 Outbreak.

PURPOSE: Considering the risk of coronavirus disease (COVID-19) transmission through infected droplets, emergency department (ED) operations in response to febrile patients should be planned. We investigated the general and clinical characteristics of febrile patients visiting the ED and changes in admission rates via the ED during the COVID-19 outbreak. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected patients who visited 402 EDs in the Republic of Korea with febrile symptoms between January 27 and May 31, 2020 and compared them to those enrolled before the COVID-19 outbreak. The primary outcome was admission rate; the secondary outcome was length of stay (LOS) in the ED. RESULTS: In total, 266519 patients had febrile symptoms at ED presentation after the COVID-19 outbreak. In 2019, before the outbreak, there were 437762 patients. The rate of ED visits among pediatric patients (aged <15 years) decreased to 21.4% after the COVID-19 outbreak, compared with 41.8% in 2019. The proportion of patients admitted after ED management was higher after the outbreak (31.3%) than before (25.2%). The adjusted odds ratio for admission was 1.04 (95% confidence interval: 1.02-1.05) after the outbreak. Compared to before the COVID-19 outbreak, the median ED LOS increased by 16 min after the outbreak. CONCLUSION: This study confirmed that admission rates and ED LOS increased for febrile patients visiting the ED after the COVID-19 outbreak. This could provide evidence for developing ED-related strategies in response to the ongoing COVID-19 outbreak and other infectious disease pandemics.

Effects of Emergency Care-related Health Policies during the COVID-19 Pandemic in Korea: a Quasi-Experimental Study.

BACKGROUND: The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period. METHODS: This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak. RESULTS: The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74-0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57-0.83) for the patients with acute myocardial infarction and 0.76 (0.67-0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: -5.3 [-6.5 to -4.2] minutes in phase 5 compared to phase 3). CONCLUSION: Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing in-hospital mortality by preventing excessive deaths.

Association between metabolic syndrome and bone mineral density in Korea: the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2008.

Little is known regarding the exact relationship between osteoporosis and cardiovascular disease. Moreover, previous research on the relationships between components of metabolic syndrome (MetS) and bone mineral density (BMD) has primarily focused on women and older men; there have been few studies in younger men. We performed a cross-sectional study to assess whether MetS is associated with BMD in the femoral neck or lumbar spine in Korean adults. We further attempted to identify the MetS component, which is the most important factor in BMD. We performed a multiple regression analysis to analyze data on 2,989 subjects from the Fourth Korea National Health and Nutrition Examination Survey. We examined the association between MetS and individuals MetS components and BMD. After adjustment for age, height, weight, smoking status, alcohol consumption and exercise, waist circumference (WC) and diastolic blood pressure (DBP) showed independent negative associations with femoral neck and spine BMD in men in all age groups. Triglyceride concentration was also negatively associated with femoral neck BMD in younger men (<45 years). In premenopausal women, WC, DBP, and high-density lipoprotein cholesterol were negatively associated with spine BMD. In postmenopausal women, WC was negatively associated with femoral neck BMD. These results suggest that WC in men in all age groups may be the most important factor in bone mineral density.

Lung function decline and blood lead among residents nearby to industrial complex.

PURPOSE: This study was to ascertain the risk factors of pulmonary function decline (forced expiratory volume in 1 s [FEV(1)], forced vital capacity [FVC]) among those exposed to lead in the vicinity of industrial complex. METHODS: In total, 263 men and women, aged over 30, were recruited from two cities during a 2-year follow-up. Spirometry testing was conducted first at baseline and then after 2-years of follow-up. The change in FVC and FEV(1) during the study period was analyzed according to blood lead (BPb), urinary cotinine, and 1-hydroxypyrene, after controlling for sex, height, baseline FVC or FEV(1), and airway hyperresponsiveness. RESULTS: With increase in age, both FEV(1) and FVC declined. More marked decline in FVC was noted for men than for women (p < 0.05), while the decline in FEV(1) was not. Biological variables, especially height (p < 0.05) and pulmonary status (p < 0.0001), were associated with the decline in both FEV(1) and FVC. Even after controlling these other variables, blood lead level was also significantly associated with the decline of FVC. CONCLUSIONS: Even though the decline in FEV(1) and FVC with aging was within a normal range, people with smaller height were more vulnerable to the decline of both FEV(1) and FVC and especially higher level of BPb was accompanied with larger decline of FVC. Oxidative stress in relation to lead accumulation in adult may contribute to rapid aging of pulmonary function.

1-hydroxypyrene as a biomarker of PAH exposure among subjects living in two separate regions from a steel mill.

OBJECTIVE: Steel mills are known to be a source of ambient polycyclic aromatic hydrocarbons (PAHs), and increased cancer risk has been reported among neighborhoods previously. In this study, we tried to assess the exposure to PAHs among residents nearby to a large steel mill in Korea by measuring urinary 1-hydroxypyrene (1-OHP). METHODS: Two separate areas at different distances from a steel mill but on the same wind direction were chosen to evaluate the environmental exposures to polycyclic aromatic hydrocarbons. Three-hundred and fifty children living in the vicinity of steel plant ("nearby" group) and 606 children residing much farther from the factory ("remote" group) participated. Urine was collected on three consecutive days, and questionnaires about exposure to passive smoking and food consumption as well as demographics were obtained. Routine monitoring data of ambient pollutants were obtained and particulate matter less than 10 microm (PM10) was analyzed with multiple regressions to assess the associations with urinary 1-OHP. RESULTS: The geometric mean concentration of urinary 1-OHP among nearby group (0.048+/-1.878 micromol/mol creatinine, GM+/-GSD) was approximately 1.3 times higher than that among remote group (0.036+/-2.425 micromol/mol creatinine, GM+/-GSD), and using multiple regression techniques, the difference was significant (P<0.0001) after adjusting for confounding variables. When different periods before the sampling of urine were examined, PM10 averages over 2 days, 3 days, and 1 week prior to urine sampling showed significant associations with urinary 1-OHP levels. CONCLUSION: Our findings are consistent with the interpretation that residents nearby to a steel mill are exposed to PAHs through ambient exposures.