Pediatric emergency department utilization during the COVID-19 pandemic in New York City
This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses. We performed an observational retrospective review of patients younge...
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| Veröffentlicht in: | The American journal of emergency medicine 2021-07, Vol.45, p.100-104 |
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| container_title | The American journal of emergency medicine |
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| creator | Sokoloff, William C. Krief, William I. Giusto, Kimberly A. Mohaimin, Tasnima Murphy-Hockett, Cole Rocker, Joshua Williamson, Kristy A. |
| description | This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses.
We performed an observational retrospective review of patients younger than 18 years old seen in a New York City 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 compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation.
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 |
| doi_str_mv | 10.1016/j.ajem.2021.02.029 |
| format | Article |
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We performed an observational retrospective review of patients younger than 18 years old seen in a New York City 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 compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation.
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 Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. 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).
Pediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse.
•Pediatric hospitalization rates and ED acuity increased with the COVID-19 pandemic.•Many of the largest decreases in visits were for common, low-acuity diagnoses.•Visits for self-harm during the pandemic were double what would have been expected.•Diagnoses of child abuse or neglect were concerningly rare.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2021.02.029</identifier><identifier>PMID: 33677263</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abuse ; Acuity ; Adolescent ; Algorithms ; Behavioral health ; Child ; Child, Preschool ; Coronavirus ; Coronaviruses ; COVID-19 ; COVID-19 - epidemiology ; Demography ; Disease ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital - statistics & numerical data ; Female ; Health care ; Humans ; Illnesses ; Incidence ; Infant ; Male ; Medical research ; Middle East respiratory syndrome ; New York City - epidemiology ; Pandemics ; Patients ; Pediatrics ; Public health ; Respiratory diseases ; Retrospective Studies ; SARS-CoV-2 ; Self-injury ; Severe acute respiratory syndrome coronavirus 2 ; State of emergency ; Suicide ; Suicides & suicide attempts ; Viral infections ; Volume</subject><ispartof>The American journal of emergency medicine, 2021-07, Vol.45, p.100-104</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><rights>2021. Elsevier Inc.</rights><rights>2021 Elsevier Inc. All rights reserved. 2021 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-9b5a30779761f7fb6620913fa844d775c8ace24595783b321ab9a8a0ecc65f693</citedby><cites>FETCH-LOGICAL-c483t-9b5a30779761f7fb6620913fa844d775c8ace24595783b321ab9a8a0ecc65f693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735675721001376$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33677263$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sokoloff, William C.</creatorcontrib><creatorcontrib>Krief, William I.</creatorcontrib><creatorcontrib>Giusto, Kimberly A.</creatorcontrib><creatorcontrib>Mohaimin, Tasnima</creatorcontrib><creatorcontrib>Murphy-Hockett, Cole</creatorcontrib><creatorcontrib>Rocker, Joshua</creatorcontrib><creatorcontrib>Williamson, Kristy A.</creatorcontrib><title>Pediatric emergency department utilization during the COVID-19 pandemic in New York City</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses.
We performed an observational retrospective review of patients younger than 18 years old seen in a New York City 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 compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation.
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 Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. 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).
Pediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse.
•Pediatric hospitalization rates and ED acuity increased with the COVID-19 pandemic.•Many of the largest decreases in visits were for common, low-acuity diagnoses.•Visits for self-harm during the pandemic were double what would have been expected.•Diagnoses of child abuse or neglect were concerningly rare.</description><subject>Abuse</subject><subject>Acuity</subject><subject>Adolescent</subject><subject>Algorithms</subject><subject>Behavioral health</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Coronavirus</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>Demography</subject><subject>Disease</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Health care</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Incidence</subject><subject>Infant</subject><subject>Male</subject><subject>Medical research</subject><subject>Middle East respiratory syndrome</subject><subject>New York City - epidemiology</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Public health</subject><subject>Respiratory diseases</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Self-injury</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>State of emergency</subject><subject>Suicide</subject><subject>Suicides & suicide attempts</subject><subject>Viral infections</subject><subject>Volume</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU2LFDEQhoMo7rj6BzxIwIuXHvPR-QIRlvFrYXE9qOgppNPVs2m7O2M6vTL-ejPMuqgHoSCHPPVSVQ9CjylZU0Ll837tehjXjDC6JqyUuYNWVHBWaaroXbQiiotKKqFO0IN57gmhtBb1fXTCuVSKSb5CXz5AG1xOwWMYIW1h8nvcws6lPMKU8ZLDEH66HOKE2yWFaYvzFeDN5efzVxU1eOemFsbSHSb8Hn7grzF9w5uQ9w_Rvc4NMzy6eU_RpzevP27eVReXb883ZxeVrzXPlWmE40QpoyTtVNdIyYihvHO6rlulhNfOA6uFEUrzhjPqGuO0I-C9FJ00_BS9PObulmaE1pehkxvsLoXRpb2NLti_f6ZwZbfx2iptZG1ECXh2E5Di9wXmbMcwexgGN0FcZstqo43WwuiCPv0H7eOSprKeZUIQSYVUpFDsSPkU5zlBdzsMJfYgzvb2IM4exFnCSh3WePLnGrctv00V4MURgHLM6wDJzj4UW0VfAp9tG8P_8n8BW7upRw</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Sokoloff, William C.</creator><creator>Krief, William I.</creator><creator>Giusto, Kimberly A.</creator><creator>Mohaimin, Tasnima</creator><creator>Murphy-Hockett, Cole</creator><creator>Rocker, Joshua</creator><creator>Williamson, Kristy A.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210701</creationdate><title>Pediatric emergency department utilization during the COVID-19 pandemic in New York City</title><author>Sokoloff, William C. ; Krief, William I. ; Giusto, Kimberly A. ; Mohaimin, Tasnima ; Murphy-Hockett, Cole ; Rocker, Joshua ; Williamson, Kristy A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-9b5a30779761f7fb6620913fa844d775c8ace24595783b321ab9a8a0ecc65f693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abuse</topic><topic>Acuity</topic><topic>Adolescent</topic><topic>Algorithms</topic><topic>Behavioral health</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Coronavirus</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - epidemiology</topic><topic>Demography</topic><topic>Disease</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Health care</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Incidence</topic><topic>Infant</topic><topic>Male</topic><topic>Medical research</topic><topic>Middle East respiratory syndrome</topic><topic>New York City - epidemiology</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Public health</topic><topic>Respiratory diseases</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Self-injury</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>State of emergency</topic><topic>Suicide</topic><topic>Suicides & suicide attempts</topic><topic>Viral infections</topic><topic>Volume</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sokoloff, William C.</creatorcontrib><creatorcontrib>Krief, William I.</creatorcontrib><creatorcontrib>Giusto, Kimberly A.</creatorcontrib><creatorcontrib>Mohaimin, Tasnima</creatorcontrib><creatorcontrib>Murphy-Hockett, Cole</creatorcontrib><creatorcontrib>Rocker, Joshua</creatorcontrib><creatorcontrib>Williamson, Kristy A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sokoloff, William C.</au><au>Krief, William I.</au><au>Giusto, Kimberly A.</au><au>Mohaimin, Tasnima</au><au>Murphy-Hockett, Cole</au><au>Rocker, Joshua</au><au>Williamson, Kristy A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric emergency department utilization during the COVID-19 pandemic in New York City</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>45</volume><spage>100</spage><epage>104</epage><pages>100-104</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses.
We performed an observational retrospective review of patients younger than 18 years old seen in a New York City 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 compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation.
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 Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. 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).
Pediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse.
•Pediatric hospitalization rates and ED acuity increased with the COVID-19 pandemic.•Many of the largest decreases in visits were for common, low-acuity diagnoses.•Visits for self-harm during the pandemic were double what would have been expected.•Diagnoses of child abuse or neglect were concerningly rare.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33677263</pmid><doi>10.1016/j.ajem.2021.02.029</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Abuse Acuity Adolescent Algorithms Behavioral health Child Child, Preschool Coronavirus Coronaviruses COVID-19 COVID-19 - epidemiology Demography Disease Emergency medical care Emergency medical services Emergency Service, Hospital - statistics & numerical data Female Health care Humans Illnesses Incidence Infant Male Medical research Middle East respiratory syndrome New York City - epidemiology Pandemics Patients Pediatrics Public health Respiratory diseases Retrospective Studies SARS-CoV-2 Self-injury Severe acute respiratory syndrome coronavirus 2 State of emergency Suicide Suicides & suicide attempts Viral infections Volume |
| title | Pediatric emergency department utilization during the COVID-19 pandemic in New York City |
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