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AHN physicians: Pediatric ER visits plummet during the pandemic

4 min read
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Courtesy of Allegheny Health Network

Dr. Arvind Venkat was one of the physicians who took part in the Allegheny Health Network study.

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Courtesy of Allegheny Health Network

Dr. Arvind Venkat was one of the physicians who took part in the Allegheny Health Network study.

New numbers show a drastic drop in the number of children who were treated in hospital emergency departments during the first months of the COVID-19 pandemic.

The numbers are not all that surprising considering the country was in the midst of a lockdown, but doctors say the information brings up some important issues.

According to a study led by three Allegheny Health Network emergency medicine physicians, pediatric visits to hospital emergency rooms declined dramatically during the start of the pandemic and outpaced a similar decline in adult visits. The study, was recently published in the American Journal of Emergency Medicine. It compared January-June 2020 to a similar period in 2019 and used data from 148 emergency departments, children’s hospitals emergency departments and urgent care centers.

Researchers found pediatric visits declined by as much as 72% compared to a 60% decline for adults.

“Our research showed declines in pediatric emergency department usage across all geographic areas and for all conditions from serious to relatively minor,” said Dr. Jesse Pines, who was one of the researchers and is an emergency physician at Allegheny General Hospital. “While some of the declines are the natural result of social distancing and school closures, we are concerned parents may be putting off care for their children’s serious or potentially serious conditions.”

The study drew on data from 144 general, pediatric and freestanding emergency departments and four urgent care centers in 18 states including a number of emergency departments in Western Pennsylvania.

What prompted the doctors to look at these numbers?

“The pandemic has had a significant number of impacts on patients and the health care system,” said Dr. Arvind Venkat, also a researcher and emergency physicians at AGH and AHN-McCandless. “Pediatric patients are of particular interest given the changes in how kids have lived during the pandemic and that emergency departments are an important venue for their care.”

The study shows that part of the decline in ER visits may have been because of fewer flu and upper respiratory cases. Emergency pediatric visits for those illnesses dropped as much as 84% during the early months of the pandemic compared to the same period a year earlier. Visits for arm fractures declined by 43% and for open head wounds by 31%.

“With school buildings closed and group sports activities limited, it’s expected that we would see fewer emergency visits for contagious diseases like the flu and for conditions such as fractures that typically happen on the playing field,” said researcher and AHN emergency physician Dr. Jestin Carlson. “We also found that the number of emergency visits for influenza was about a fifth of 2019 levels giving us hope that this may portend a milder-than-usual influenza season for 2020-2021.”

Venkat said it makes sense the drop in those types of cases coincided with a lull in school and organized sports.

“We believe this is due to kids doing less activities that might result in requirements for ED care,” he said. “For example, if kids are largely at home, they are not with other kids that can spread infections or doing sports that might result in injuries.”

The takeaway from the study is that fewer kids may have needed treatment for illnesses and injuries, but Venkat said there’s an underlying concern.

“For serious conditions, we are concerned this stems from fears among parents and guardians for the safety of their children receiving care in the (Emergency Department) during the pandemic,” Dr. Venkat says. “This is problematic as for serious pediatric conditions, not receiving care in the (Emergency Department) can result in delays that worsen outcomes.”

Since many states have eased pandemic restrictions and schools and sports started up again in the fall, the doctors say they have seen a rise in pediatric ER visits once again.

“We have unpublished data that pediatric visits have risen,” Venkat said, “but still below 2019 levels and less than the rise in the same period of adult visits.”

The lower-than-usual numbers for pediatric emergency visits continued into June 2020. Researchers say further investigation will be needed to determine the impact of this phenomenon on children’s health.

“One of the reasons that we are publishing this data is that we want to send a message to parents and guardians that emergency departments are safe for the care of their children, even during the pandemic,” Venkat said. “We have better understanding of the virus, personal protective equipment and protocols for protecting children, parents/guardians and staff.”

“Emergency departments are there for anyone with any condition at any time,” he added. “We fear that avoidance of emergency department care, especially for serious conditions, could result in delays in care and worse clinical outcomes for children.”

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