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Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study. 2022
Ruud G Nijman, and
Kate Honeyford, and
Ruth Farrugia, and
Katy Rose, and
Zsolt Bognar, and
Danilo Buonsenso, and
Liviana Da Dalt, and
Tisham De, and
Ian K Maconochie, and
Niccolo Parri, and
Damian Roland, and
Tobias Alfven, and
Camille Aupiais, and
Michael Barrett, and
Romain Basmaci, and
Dorine Borensztajn, and
Susana Castanhinha, and
Corinne Vasilico, and
Sheena Durnin, and
Paddy Fitzpatrick, and
Laszlo Fodor, and
Borja Gomez, and
Susanne Greber-Platzer, and
Romain Guedj, and
Stuart Hartshorn, and
Florian Hey, and
Lina Jankauskaite, and
Daniela Kohlfuerst, and
Mojca Kolnik, and
Mark D Lyttle, and
Patrícia Mação, and
Maria Inês Mascarenhas, and
Shrouk Messahel, and
Esra Akyüz Özkan, and
Zanda Pučuka, and
Sofia Reis, and
Alexis Rybak, and
Malin Ryd Rinder, and
Ozlem Teksam, and
Caner Turan, and
Valtýr Stefánsson Thors, and
Roberto Velasco, and
Silvia Bressan, and
Henriette A Moll, and
Rianne Oostenbrink, and
Luigi Titomanlio, and
Department of Pediatric Emergency Medicine, Division of Medicine, St. Mary's hospital-Imperial College NHS Healthcare Trust, London, United Kingdom.
During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258.
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