The Ongoing Impact of COVID-19 on Pediatric Emergency Health-Seeking Behavior in New York City

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Background: COVID-19 has had a unique sparing effect on children.  Worldwide reports describe significant declines in pediatric emergency department (PED) visits during the pandemic, suggesting that the effects of the virus extend to all pediatric conditions, related or unrelated to COVID-19.  The Bronx, an early COVID-19 epicenter, has the highest incidence of asthma in the United States (US). The ongoing impact of COVID-19 in an early epicenter on PED presentations, including asthma, has not been studied beyond the pandemic peak and into the state phased re-openings.    

Objective: To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019.   

Design/Methods: Retrospective chart review of children <21 years old utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 – July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to one of eight pre-determined diagnostic categories. Demographic and clinical data were compared.  

Results: 19,981 PED visits were included. Visits declined by 66% during the pandemic and through NYS phase II re-opening. The Pandemic cohort was categorized as having higher acuity (24% vs. 17%, p<0.0001) and admission rates (17% vs. 11%, p<0.0001).  Proportions of visits with major medical problems (13% vs. 8%, p<0.0001), appendicitis (1% vs. 0.4%, p<0.0001) and other surgical complaints (1% vs. 0.5%, p<0.0001), were higher in the pandemic cohort, while declines in the pandemic cohort were observed in minor medical problems (61% vs. 67%, p<0.0001) and asthma (2% vs. 7%, p<0.0001) visitsNo significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. 

Conclusion: The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase II re-opening. Asthma-related diagnoses significantly decreased in the pandemic cohort. Future studies re-evaluating previously described asthma triggers are warranted. 


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The Children's Hospital at Montefiore / Albert Einstein College of Medicine
The Children's Hospital at Montefiore / The Albert Einstein College of Medicine
Albert Einstein College of Medicine
The Childern's Hospital at Montefiore
The Childrens Hospital at Montefiore

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