Fellow Children's Hospital at Montefiore The Children's Hospital at Montefiore General Pediatrics, New York, United States
Background: The Bronx has the highest incidence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening.
Objective: To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019.
Design/Methods: Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children’s hospital in The Bronx, NY from March 15th 2020 – July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared.
Results: 19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p<0.0001) and minor medical problems (61% vs. 67%, p<0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p<0.0001), appendicitis (1% vs. 0.4%, p<0.0001) and other surgical complaints (1% vs. 0.5%, p<0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. Conclusion(s): The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort, suggesting that environmental factors may play a more significant role in asthma pathogenesis.
Authors/Institutions: Rachel Levene, The Children's Hospital at Montefiore General Pediatrics, Bronx, New York, United States; Daniel M. Fein, The Children's Hospital at Montefiore General Pediatrics, Bronx, New York, United States; Ellen J. Silver, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, United States; Joanna R. Joels, Children's Hospital at Montefiore, Bronx, New York, United States; Hnin Khine, The Children's Hospital at Montefiore General Pediatrics, Bronx, New York, United States