When the pandemic hit, an urban children’s hospital saw a dramatic decline in the volume of emergency department (ED) visits, as shown in the above chart. Although children are less likely to suffer severe COVID-19 illness, the pandemic nevertheless disrupted previous patterns of emergency care for pediatric patients. That’s the take-home message in a new cross-sectional study in The Journal of Pediatrics by Barbara Chaiyachati and colleagues.

The authors compared the number and type of ED visits for the first 16 weeks of 2020 to the prior three years (2017 through 2019). The number of visits for all four years was similar from the beginning of the year until week 10 of 2020, around the time the first COVID-19 case was locally reported.  

In the 30 days after the first local stay-at-home order was issued in 2020, the hospital had a daily average of 95 pediatric ED visits, down from an average of 286 per day in the same calendar period in the previous three years.

The authors also found several differences in the types of patients and care needs seen in the ED in 2020, compared to previous years, with smaller proportions of African American patients and patients who were publicly insured. A higher percentage of patients were labeled as high acuity (59.4% vs 49.6%), which was consistent with the higher proportion of patients admitted to inpatient and the ICU. The top 20 chief complaints were similar to those of prior years, except ingestion was a top 20 complaint only in 2020.

As the authors note, these data suggest that the shifting environment following stay-at-home orders may place children at new, modifiable risk, and identifies an important area of public health education and intervention. These utilization trends should help pediatric providers understand the changing needs of the populations they serve, and work within their communities to ensure that children and their families receive appropriate care during the pandemic.

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The study, “Trends in Pediatric Emergency Department Utilization after Institution of COVID-19 Mandatory Social Distancing” was published in The Journal of Pediatrics in July 20, 2020. Authors include Barbara H. Chaiyachati, Atu Agawu, Joseph J. Zorc, and Fran Balamuth.