key: cord-1002680-yfrmvrvi authors: Annie Chiu, Ting Gee; Leung, William CY.; Zhang, Qiqi; Lau, Eric HY.; Ho, Ryan Wui-hang; Sophelia Chan, Hoi-Shan; Chang, Richard Shek-kwan title: Changes in pediatric seizure-related emergency department attendances during COVID-19 – a territory-wide observational study date: 2020-11-21 journal: J Formos Med Assoc DOI: 10.1016/j.jfma.2020.11.006 sha: ccbff1d823aced1aeb26b8e10814694cbfd0257f doc_id: 1002680 cord_uid: yfrmvrvi A territory-wide retrospective observational study was conducted in Hong Kong between January 23 to April 22, 2020 to demonstrate changes in pediatric seizure-related accident and emergency department (A&E) visits during the COVID-19 pandemic. Parallel periods from 2015 to 2019 were used as control. All-cause A&E attendances in all paediatric age groups decreased significantly during the study period. Seizure-related attendances decreased across all pediatric age-groups in 2020 (RR 0.379, 95% CI 0.245-0.588), with a disproportionately large decrease in the 0-6 years age group (RR 0.303, 95% CI 0.174-0.526) compared with the 7-18 years age group (RR 0.534, 95% CI 0.393-0.719). Decrease in RTI-related A&E attendances was also more drastic in the 0-6 age group. The two time trends are congruent in the 0-6 years but not the 7-18 years age group. Such a trend is suggestive of the usefulness of infection control measures in seizure prevention, especially amongst young children. A territory-wide retrospective observational study was conducted in Hong Kong between January 23 to April 22, 2020 to demonstrate changes in pediatric seizurerelated accident and emergency department (A&E) visits during the COVID-19 pandemic. Parallel periods from 2015 to 2019 were used as control. All-cause A&E attendances in all paediatric age groups decreased significantly during the study period. Seizure-related attendances decreased across all pediatric age-groups in 2020 (RR 0.379, 95% CI 0.245-0.588), with a disproportionately large decrease in the 0-6 years age group (RR 0.303, 95% CI 0.174-0.526) compared with the 7-18 years age group (RR 0.534, 95% CI 0.393-0.719). Decrease in RTI-related A&E attendances was also more drastic in the 0-6 age group. The two time trends are congruent in the 0-6 years but not the 7-18 years age group. Such a trend is suggestive of the usefulness of infection control measures in seizure prevention, especially amongst young children. The worldwide pandemic of Coronavirus Disease 2019 (COVID-19) has brought about an unprecedented public health challenge on a global basis 1 , and impacted heavily on the workload of the Accident & Emergency Department around the world 2 3 . Drops in A&E visits has been observed amongst patients seeking medical care for reasons other than suspected COVID-19 3 4 , including that amongst children 5 and patients with epilepsy 6 . Seizure is one of the commonest cause for Accident & Emergency Department (A&E) visits in children 7 8 . The pandemic offers a unique timeframe to better understand the dynamics of health seeking behaviour amongst children with seizure. We thus examined pediatric seizure-related A&E visits through conducting a territory-wide observational study during the first wave of COVID-19 pandemic in Hong Kong, during which there was relatively low burden of COVID-19 cases but a series of strict infection control measures were implemented by the health authorities 9 10 . were selected as control periods. Statistics for all-cause A&E attendance, respiratory tract infections (RTIs)-related A&E attendance, and seizure-related A&E attendance and ward admissions were retrieved from CDARS (see Supplementary Table 1 The time trends of seizure-and RTI-related A&E attendances were congruent in the 0-6 years age group (test for difference in time trends, p=0.650) but not in the 7-18 age group ( Figure 1A & B) . In view of the above findings, seizure-related admissions from children aged 0-6 years old were further divided into febrile and afebrile subgroups for subgroup analysis. Whilst the afebrile seizure-related admissions were halved, the febrile J o u r n a l P r e -p r o o f seizure-related admission dropped to less than 20% of the previous year, and was disproportionately greater (Supplementary Figure 1A & B) . A total of 2,241 seizure-related admissions during the study period were included. The acute ward in-patient admission rate, mortality rate, and rate of early A&E readmissions remained stable between 2015 and 2020 (Table 1) , and the LOSs in acute ward and ICU did not change significantly during COVID-19. The COVID-19 pandemic has deeply affected many aspects of people's lives, including personal hygiene practices, suspension of schools and social activities, quarantine policies and travel restrictions. This study demonstrated change in seizure-related health seeking behavior, and the possible effect of social distancing on the incidence of seizure-related complaints in children during this global public health crisis. We found that seizure-related A&E attendances decreased significantly during the periods of vigilant social distancing under COVID-19, with a disproportionately large effect on the 0-6 years age group compared to older pediatric age groups. A similar trend was found for A&E attendances for RTI during the same period. The observed trend may be due to both an actual reduction in seizure occurrences and changes in health-seeking behavior. Social distancing and hygienic precautions World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19) Patient visits to an emergency department in anticipation of the COVID-19 pandemic Impact of the COVID-19 Pandemic on Emergency Department Visits -United States Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage Changes in Children's Healthcare Visits During COVID-19 Pandemic in Hangzhou Did the COVID-19 pandemic silence the needs of people with epilepsy? Study of seizure and epilepsy in Chinese children in Hong Kong: period prevalence and patterns Emergency department admission of children with unprovoked seizure: recurrence within 24 hours The Government of the Hong Kong Special Administrative Region. Latest Situation of Coronavirus Disease (COVID-19) in Hong Kong An observational study of febrile seizures: the importance of viral infection and immunization Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study) Facemasks for the prevention of infection in healthcare and community settings Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review Tracking health seeking behavior during an Ebola outbreak via mobile phones and SMS National Center for Inectious Diseases SCOT. Fear and stigma: the epidemic within the SARS outbreak Monitoring community responses to the SARS epidemic in Hong Kong: from day 10 to day 62 The authors would like to acknowledge Mrs. R. Wong for her assistance with English editing.