Background
Pediatric emergency department (ED) volumes dropped significantly worldwide during the COVID-19 pandemic. However there is limited reports of the severity of illness and the nature of the pathology of those children who did visit the ED during the early months of the pandemic.
Objective
This study describes the comprehensive utilization of a pediatric ED during the early months of the COVID-19 pandemic in New York, including the impact on visit acuity and incidence of common diagnoses.
Study Design
We performed an observational retrospective review of patients younger than 18 years old seen in a New York pediatric ED from March 7th to May 6th 2020, and during the same time period in 2018 and 2019. Demographics, visit details, diagnoses, and dispositions were assessed. Practical diagnosis groupings were created using the U.S. Agency for Healthcare Research and Quality's Clinical Classification Software Refined, and the probability of a visit requiring emergent evaluation was estimated using the NYU-ED Algorithm.
Results
ED visits during the pandemic decreased by 56% to an average daily census of 67 patients, from an anticipated 152. Admission rates rose from 13.3% to 17.4% (p<0.001), and the proportion of triage ESI level 2 patients increased by 26% (p<0.001). Non-emergent visits dropped from 32.5% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including nausea, vomiting and diarrhea (76% decrease, p<0.001) which previously made up 8.1% of all ED visits. Concerningly, visits for suicidal ideation, suicide attempt, or self-harm increased by 100% (p<0.001) and visits for evaluating abuse or neglect decreased by 89% (p=0.01).
Conclusions
ED utilization substantially deceased during the early months of the COVID-19 pandemic. Despite low volumes, pediatric healthcare systems must prepare for relatively higher patient acuity and recognize the disproportionate impact the pandemic has on certain diagnoses and vulnerable groups.
