key: cord-0811096-859sozav
authors: Jacob, Ron; Weiser, Giora; Padeh, Gabi; Maimon, Michal; Takagi, Dania; Cohen, Naama Kuchinski; Klein, Adi; Sharkansky, Livnat; Chistyakov, Irena; Shavit, Itai
title: Complications of serious acute conditions in children during the COVID-19 pandemic
date: 2021-02-21
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2021.02.042
sha: d7fe64041d511b9273189d70d8ab1bdecda1d4c7
doc_id: 811096
cord_uid: 859sozav

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(5-11) days. Rates of intensive care units' admissions in patients with CSAC in 2019 and 2020 were 13/81 (16%) and 17/85 (20%), respectively; p=0.550.

The major finding of this study is that despite the significant (40.2%) reduction in PEDs visits during the pandemic period, there was no statistically significant difference in the overall CSAC rate, and in the complications rates of appendicitis, diabetic ketoacidosis, testicular torsion, ileocolic intussusception, septic arthritis, orbital cellulitis, and meningitis, between the pandemic and pre-pandemic periods. The two cohorts were similar with regard to age, sex, method of arrival to the PED, arrival time, and triage acuity level, and were also similar with regard to hospital length-of-stay and ICU admissions. These findings suggest that the severity of serious acute conditions and their management were similar in both study periods.

Higher rates of complications of mastoiditis were found in the pandemic period. Since many ambulatory practices in Israel delayed, canceled, or converted to telemedicine [5], we speculate that a higher rate of untreated purulent otitis media lead to the higher rate of complications of mastoiditis seen in the PED. There were also more complications of sepsis in 2020 than in 2019 (6/7 vs 3/11), but the small group size limits interpretation of this finding.

Our study has certain limitations including the inherent limitations of a retrospective study design. We investigated the first three months of the outbreak; therefore, only a few patients were tested for COVID-19, and the new disease known as multisystem inflammatory syndrome in children (MIS-C) was not included in the data. Since healthcare systems vary greatly across countries, our findings may not be generalizable to other populations.

In summary, study results suggest that the overall CSAC rate was not increased during the first months of the outbreak in Israel. CSAC rate analysis can be used by healthcare organizations to evaluate the impact of the outbreak on pediatric emergency medicine. 

For all 10 authors, there are no potential conflicts of interest, real or perceived in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the paper for publication.

Dr Jacob designed the study, analyzed and interpreted the data, reviewed the literature, and critically revised the article; Dr Weiser designed the study, analyzed and interpreted the data, reviewed the literature, and critically revised the article. Dr Weiser has equal contribution as first author; Drs Padeh, kaplan, Maimon, Takagi, Peled, Gamsu, Krupik, Kuchinski Cohen, Klein, Gur-Soferman, Sharkansky and Chistyakov analyzed and interpreted the data, carried out the initial analysis and critically revised the article; IS conceived the idea for the study, analyzed and interpreted the data, and drafted the manuscript. IS has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. 

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