Pediatric emergency department utilization during the COVID-19 pandemic in New York City.
Pediatric emergency department utilization during the COVID-19 pandemic in New York City.
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DOI：
10.1016/j.ajem.2021.02.029
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Williamson KA
中科院分区：
文献类型：
--
作者：
Sokoloff WC;Krief WI;Giusto KA;Mohaimin T;Murphy-Hockett C;Rocker J;Williamson KA
本研究描述了在美国最初的震中地区，在COVID-19大流行的最初几个月期间，儿科急诊科（艾德）的利用情况，包括对就诊紧急程度和常见诊断发生率的影响。我们对2020年3月7日至5月6日以及2018年和2019年同期在纽约市儿科艾德就诊的18岁以下患者进行了一项观察性回顾性审查。比较人口统计学、访视详情、诊断和处置。使用经验证的算法创建实际诊断分组，并确定需要紧急评价的访视概率。大流行期间的艾德就诊人数从预期的152人下降到平均每天67人，下降了56%。入院率从13.3%上升到17.4%（p<0.001），分诊紧急严重程度指数1级和2级患者的比例增加了23.7%（p<0.001）。非急诊就诊率从32.3%降至27.5%（p<0.001）。几种常见的，通常是低敏度的诊断看到了不成比例的减少访问，包括头痛，胸痛，轻伤。令人担忧的是，自杀意念，自杀企图或自我伤害的访问增加了100%（p<0.001），评估虐待或忽视的访问减少了89%（p=0.01）。在纽约市COVID-19大流行的最初几个月，儿科艾德使用率大幅下降，但患者的紧急程度相对较高。早期震中的医疗保健系统还必须为大流行对最脆弱的儿科患者，特别是那些有自我伤害或虐待风险的患者造成的不成比例的影响做好准备。
This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses. We performed an observational retrospective review of patients younger than 18 years old seen in a New York City pediatric ED from March 7th to May 6th 2020, and during the same time period in 2018 and 2019. Demographics, visit details, diagnoses, and dispositions were compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation. ED visits during the pandemic decreased by 56% to an average daily census of 67 patients, from an anticipated 152. Admission rates rose from 13.3% to 17.4% (p<0.001), and the proportion of triage Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. Concerningly, visits for suicidal ideation, suicide attempt, or self-harm increased by 100% (p<0.001) and visits for evaluating abuse or neglect decreased by 89% (p=0.01). Pediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse.
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