Analysis of pediatric emergency department patient volume trends during the COVID-19 pandemic.

ABSTRACT: During the early period of the COVID-19 pandemic there was a substantial decrease in pediatric emergency department (PED) visitation. The intent of this study is to report PED utilization during the COVID-19 pandemic in an urban pediatric referral center located close to the epicenter in the northeastern US.A retrospective analysis of medical records of patients visiting the PED at Robert Wood Johnson University Hospital (RWJUH) was performed. Data included: daily census, admission rate, Emergency Severity Index, and ICD-10 diagnosis codes for the period of February through July, 2018 to 2020.By the week of March 26th, visits had decreased by 70% compared to the average of the previous 2 years. This census nadir lasted for 6 weeks. At 5 weeks postnadir the average daily census recovered to levels 40% lower than prior year norms and remained at that level during subsequent months. The greatest decreases were seen in low-acuity visits. Visits for behavioral health and fractures decreased by approximately 50% and 70%, respectively, but recovered to prior year norms by June and July of 2020. Visits for asthma exacerbation decreased by as much as 87% and remained at record lows for the remainder of the study period.A substantial and persistent decrease in PED visitation was experienced during the COVID-19 pandemic. Whereas visits for behavioral health and fractures have recovered to prior year norms, visits for asthma exacerbation remain at record lows. Further research is needed to ascertain the causes of these changes, including patient perceptions of the PED.

Incidence and Geographic Distribution of Injuries Due to Falls Among Pediatric Communities of Maryland.

OBJECTIVES: Falls are the leading cause of pediatric injury and account for the majority of emergency department injury visits, costing US $5 billion in medical costs annually. Epidemiology of pediatric falls has primarily been studied at single hospital centers and has not been analyzed statewide. We assessed pediatric falls across Maryland and geographically mapped them by census tract and block group. METHODS: The study used Maryland Health Services Cost Review Commission discharge data to retrospectively analyze the demographics and cross-sectional incidence rates of fall injuries in Maryland from 2013 to 2015. Geographical clusters were calculated for pediatric falls in Maryland and Baltimore City. RESULTS: From 2013 to 2015, Maryland hospitals discharged 738,819 pediatric patients, of whom 77,113 had fall injuries. Falls were more prevalent among males (56%), white race (55%), and patients with public insurance (56%). Over this period, 2 children who presented with fall injuries died. The incidence of falls did not vary from 2013 (27,481 children) to 2014 (27,261) and 2015 (26,451). Mapping fall injuries across Maryland identified Baltimore City as the primary cluster and rural pockets as secondary clusters of high incidence rates. Baltimore City maps showed a stable high-incidence cluster in the southwest region across all 3 years. CONCLUSIONS: Pediatric fall injuries comprise a large volume of emergency department visits yet have a low mortality. Geographic mapping shows that fall incidence varies across the state and persists over time. Statewide geographic information can be used to focus resource management and target prevention strategies.

Racial and ethnic differences in the rates of urinary tract infections in febrile infants in the emergency department.

OBJECTIVE: To characterize the racial and ethnic differences in rates of urinary tract infections among febrile infants who present to an urban pediatric emergency department. METHODS: A retrospective chart review was conducted using the medical records of an urban pediatric emergency department from the period between 5/2002 and 1/2003. Data were collected from infants aged 1 to 24 months from whom urine cultures were obtained as part of their fever workup. Demographic data were recorded as provided by the parents or caregivers of the patients. Urine culture results were also recorded. RESULTS: Four hundred and sixty five children had urine cultures performed during the study period and fulfilled the inclusion criteria. Parents characterized the children as white (45%), Hispanic (27%), African American (20%), Asian (3.9%), or others (4.3%). Clinical parameters including the height of fever, age of the patient, and proportion of men were similar between the subjects in each racial and ethnic group. Sixty-four children were diagnosed as having UTI. The overall prevalence of UTI was 14% (95% confidence interval [CI] 11%-17%). Rates of UTI (SD) were as follows: Asian 22% (10%), white 16% (2.4%), Hispanic 16% (3.1%), African American 4.0% (1.9%), and Others 11 % (6.2%). African American infants had a lower rate of UTI (p = 0.007) compared with the general population. The odds ratio (OR) of UTI in white versus African American children and Hispanic versus African American children were 4.4 (95% CI, 1.5 to 12.6) and 4.6 (95% CI, 1.5 to 13.9), respectively. These results were consistent after adjustment for sex. CONCLUSIONS: Urinary tract infections were common in our study population of racially and ethnically diverse children. Given similar clinical parameters, white and Hispanic children were much more likely to be diagnosed with UTI than African-American children.