Medical student Universite de Montreal Faculte de Medecine University of Montreal Montreal, Quebec, Canada
Background: COVID-19 and public health measures to contain it, have had significant impact on health systems, including pediatric emergency departments (EDs).
Objective: We aimed to describe variations in pediatric ED visits during the first three months of the COVID-19 pandemic in Canada, compared to a historical control period.
Design/Methods: We performed a retrospective cohort study of children presenting to the two academic pediatric EDs in Quebec, Canada. The main exposure of interest was the period during which the patient was seen: pre-COVID period (March-May 2015-2019) vs. COVID period (March-May 2020) and the primary outcome was the overall number of weekly ED visits during the study period. This was conducted first in a bivariate analysis using the Mann-Whitney U test, then in a multivariate Poisson regression model, adjusting for hospital and baseline trend. The same analyses were subsequently used to estimate the impact of the COVID period on other covariates: patient age categories, CTAS levels (Canadian Triage and Acuity Scale), shift of the visit, and ED disposition during the pre-COVID vs. COVID period.
Results: From 2015 to 2019, the two EDs had a median of 1,632 visits per week [interquartile range (IQR) 1,548; 1,703]; in 2020, this number decreased to 536 visits per week [IQR 446; 744] (Table 1, Figure 1). In multivariable analyses, this represented a 53.3% (95%CI: 52.1, 54.4) reduction in the number of ED visits. The reduction was larger among visits triage categories 4 and 5 (lower acuity) than categories 1, 2 and 3 (higher acuity): -54.2% vs. -42.0% (p<0.001) (Table 1). A greater proportion of children presenting to these sites were hospitalized during the COVID period than in pre-COVID period: 11.8% vs. 5.5% (p<0.001) (Table 1). Finally, the number of patients who left without being seen decreased during the COVID period compared to pre-COVID (9.5% vs. 1.3%., p<0.001) (Table 1). Conclusion(s): In the first wave of theCOVID-19 pandemic (March to May 2020), there was a 53.3% decrease in visits to pediatric EDs compared to historical control. Patients presented with higher acuity at triage and the proportion of hospitalized patients increased. It is important to examine and monitor trends in ED visits, including the acuity of these visits and the categories of diagnoses made, as they provide insight into collaterals effects of the COVID-19 pandemic.