The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter.
The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter.
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DOI：
10.1016/j.ajem.2021.01.072
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Khine H
中科院分区：
文献类型：
--
作者：
Levene R;Fein DM;Silver EJ;Joels JR;Khine H
布朗克斯区是美国哮喘发病率最高的地区，也是早期的 COVID-19 震中，使其成为一个独特的研究地点。全球报告描述了新冠肺炎 (COVID-19) 期间儿科急诊 (PED) 就诊人数大幅下降。在疫情高峰期之后以及各州重新开放的早期阶段，尚未研究过 COVID-19 对早期震中所有 PED 表现（包括哮喘）的持续影响。比较 2020 年大流行期间以及随后纽约州 (NYS) 最初分阶段重新开放期间与 2019 年同期的 PED 求医行为和临床特征。对 2020 年 3 月 15 日至 2020 年 7 月 6 日（大流行队列）和同一时间间隔在纽约州布朗克斯市一家大容量四级儿童医院使用 PED 的 21 岁以下儿童进行回顾性图表审查2019 年（比较队列）。就诊被分配到预先确定的诊断类别。比较人口统计学和临床数据。其中包括 19,981 次访问。 2020 年就诊人数下降了 66%。在大流行队列中，哮喘就诊比例（2% vs. 7%，p < 0.0001）和轻微医疗问题（61% vs. 67%，p < 0.0001）显着下降，而重大医疗问题（13% vs. 8%，p < 0.0001）、阑尾炎（1% vs. 0.4%，p < 0.0001）的比例显着下降。 p < 0.0001）和其他手术投诉（1% vs. 0.5%，p < 0.0001）在大流行队列中呈比例增加。两组之间的心理社会和创伤组之间没有发现显着的比例变化。大流行队列的 PED 数量大幅减少，但敏锐度和入院率有所增加，这种情况在纽约州第二阶段重新开放期间得以持续。尽管位于哮喘中心，但在大流行队列中，与哮喘相关的 PED 就诊率明显下降。未来的研究有必要检验室内单独过敏原对小儿哮喘的影响。
The Bronx has the highest prevalence 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. 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. 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. 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. 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. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted.
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