key: cord-1048428-z2idyqyx authors: Fidancı, İlknur; Taşar, Medine Ayşin; Akıntuğ, Bahar; Fidancı, İzzet; Bulut, İsmail title: The impact of the COVID‐19 pandemic on paediatric emergency service date: 2021-06-05 journal: Int J Clin Pract DOI: 10.1111/ijcp.14398 sha: 4829bcba1c60450da759d83b00482155e4871d6b doc_id: 1048428 cord_uid: z2idyqyx AIMS: The aims of this research were to review patients visiting the paediatric emergency department over a 6‐month period 1 year before and during the pandemic, to review paediatric emergency department referral ratios and to determine whether there were any significant decreases in mortality and morbidity. METHODS: All patients from the ages of 0 to 18 years visiting the University of Health Sciences, Ankara Research and Training Hospital, paediatric emergency service from April‐October 2019 to April‐October 2020 with no missing information in their records were involved in this retrospective cross‐sectional study. RESULTS: The total number of paediatric emergency service consultations was 74 739; the number of emergency visits from April to October 2019 was 55 678, whereas it was 19 061 from April to October 2020 in the midst of the COVID‐19 pandemic period. There was a 67.7% decrease in consultations during the pandemic period. The mean age of participants from April to October 2019 was 8.11 ± 5.31 years, and 52.4% of cases were male. The mean age from April to October 2020 was 8.58 ± 5.93 years, and 51% of cases were male. COVID‐19‐related symptoms were higher during the pandemic period (P < .05), with fever and gastroenteritis being the most frequently received diagnosis in both periods. During the pandemic period, the newborn consultation ratio was higher (P > .05), there was a decrease in consultation ratios related to suicide attempts (P < .05), and a threefold increase in death rates was observed (P < .05). CONCLUSION: In Turkey, where emergency consultation rates are quite high, these decreases look fearsome for secondary injuries that can develop in children. For this reason, families should be made aware of the importance of bringing their children to the hospital during emergencies, and that all necessary health precautions are being taken to decrease the spread of infection in hospitals. prevents them from bringing their children to emergency service departments. 3, 4 With the closure of in-class lessons at schools, a significant decrease in infectious diseases has been observed in many countries. 5, 6 Schools were closed to students and teachers in Turkey on 16 March 2020, resulting in children receiving their educations at home and staying away from crowded areas. This situation has contributed to the decrease of infectious diseases, which are the most frequent reason for the referral of children to emergency departments. The aim of this study was to assess the impact of the first 6 months of the COVID-19 pandemic on the number and type of consultations to the paediatric Emergency Department (ED) and whether there was any effect on paediatric ED-related morbidity and mortality. All patients from the age of 0 to 18 years who visited the University of Health Sciences, Ankara Research and Training Hospital, paediatric emergency service from April-October 2019 to April-October 2020 with no missing information in their records were involved in this retrospective cross-sectional study. This hospital is located at the centre of Ankara, the capital of Turkey and the socioeconomic level of incoming patients is typically low, with approximately 10% of them being Syrian refugees. Patients generally come from the outskirts of the city from a distance of about 50 km. The Chronic disease information for the participants in the consultations could not be accessed. The symptoms included as COVID-19-related symptoms are fever, cough, upper respiratory tract infection, nausea-vomiting and diarrhoea. As the pandemic was declared in Turkey on 11 March 2020, the data from April were examined in this research. All participants with complete data were included in the study. Emergency service at this hospital is available 24 hours a day, 7 days a week and is rendered by a monthly rotation of four to five paediatric residents under the guidance of two paediatric emergencies specialists' weekdays from 8 am to 4 pm and one paediatrician from 4 pm to 8 am on weekdays and weekends. Electronic data records (including patient age, gender, and distribution of total number of consultations for admission diagnosis by month) for patients who visited the paediatric emergency service in 2019 and 2020 from the months of April to October were accessed for the purposes of data collection. Statistical analysis of the study was performed by using SPSS 18.0 and Microsoft Office Excel 2003. The descriptive values of the obtained data were calculated as number and percentage frequency and mean ± standard deviation. The chi-square test was used for the categorical comparison of groups, while t-tests for the difference between two independent means were used for comparison in terms of properties specified by measurement. The mean of more than two groups was compared with variant analysis. Regression analysis was used for the investigation of relationships between variables. A P value of <.05 was considered statistically significant. The total number of paediatric emergency service consultations dur- Table 1 , comparing the same periods (April-October) in 2019 and 2020. As a result of pandemic restrictions and fear of disease transmission, the number of hospital emergency service admissions decreased significantly. Experiences are shared by analysing consultations to the paediatric emergency department during the pandemic period and evaluating these consultations. The number of patients visiting the emergency service for this issue decreased six-fold, although the percentage of patients increased by half. However, this situation was not statistically significant (P = .743) ( Table 2) . The disease of upper airway 469 (2.5) second level of the hospital. It was determined that the period before the pandemic and being a Turkish citizen significantly affected admission to intensive care in a statistically significant way (P < .001) ( Table 3) . Before the pandemic period, death and consultation to paediatric intensive care units showed a low level of positive correlation (r = 0.13, P < .001; r = 0.40; P < .001), being a Turkish citizen was found to be negatively correlated at a low level (r = −0.012, P = .001) ( Table 4 ). With the arrival of the COVID-19 outbreak, there was great fear and panic all over the world. 5 Twelve cases of children, of which four died, admitted to the paediatric intensive care unit were reported with a severe clinical picture associated with COVID-19 parental anxiety. 10 Likewise, during the pandemic period, delayed cancer cases and high mortality rates were reported from the United States. 11 In the present study, the number and rate of deaths increased significantly during the pandemic period. This situation reveals that, even though COVID-19 is not fatal in children and is believed to be asymptomatic in that age group, 1, 12 families are hesitant about the possibility of hospital-borne contamination when bringing their children to the hospital even in emergency situations. So, the greatest danger is the increase in delayed and unmet need, in other words, the increase in cases of neglect. 13, 14 In this study, it can be seen that the period when the cases decreased the most coincided with the period when the epidemic had just started in the country, when the uncertainty was more. In Turkey, as of 16 March 2020, schools were closed and community gatherings and travel were restricted, meaning that children spent more time at home and were protected from infectious diseases. This is another reason explaining the decline in emergency consultations. Newborn consultations were considered a special group during the pandemic period, and when these consultations are examined more closely, although there was a decrease in the number of consultations compared with the previous year, it was not found to be statistically significant. In one case report, in which the rate of referrals to neonatal intensive care units of multiple centres during and before the pandemic period was presented, it was determined that the rate of admissions to neonatal intensive care units decreased significantly, and it was emphasized that these results may depend on factors such as the mothers' pregnancy period being more comfortable because of resting at home, removal from crowds and transmission risks, and being away from other risk factors that could trigger premature birth. 15 In the present study, although the number of newborn consultations seems to be lower during the pandemic period, when consultation rates are investigated, they were found to be higher than the previous year. An assumption can be made here Step TA B L E 3 Regression analysis of variables for pre-and post-pandemic that this situation may be because of inexperience (ie, this is the first child for the family) or the fact that anxiety about something happening to the baby is higher than anxiety related to possible coronavirus transmission. The consequences of the pandemic regarding suicide may vary depending on public health control measures, socio-cultural and demographic structures of the countries, access to face-to-face teleconferencing for patients, and available support. 16 In the current study, the number of consultations for suicide intervention decreased significantly, which suggests that this can be the effect of being under the supervision of families at home and staying away from negative social environments, school, and friends. While some studies in the literature suggest our study, 9 that suicide attempts have increased in others. 17 The greatest limitation of this study was that it was conducted in a single centre. However, since there was a large patient base, choosing the 10 most frequently entered diagnoses and focussing on those was the best course of action. emergencies, and that all necessary health precautions are being taken to decrease the spread of infection in hospitals. This study only involved human participants. Informed consent was obtained from all individual participants included in the study. and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All of the authors declare no conflict of interest concerning the research, authorship or publication of this article. Data sharing not applicable to this article as no datasets were generated or analysed during the current study. İlknur Fidancı https://orcid.org/0000-0002-8640-297X Medine Ayşin Taşar https://orcid.org/0000-0003-4367-725X Bahar Akıntuğ https://orcid.org/0000-0002-7302-2564 İzzet Fidancı https://orcid.org/0000-0001-9848-8697 İsmail Bulut https://orcid.org/0000-0002-7084-8002 General's Remarks at the Media Briefing on 2019-nCoV on 11 Republic of Turkey Ministry of Health Disappearing act: COVID-19 and paediatric emergency department attendances Children's emergency presentations during the COVID-19 pandemic Effective health communication-a key factor in fighting the COVID-19 pandemic SARS-CoV-2 infection in children COVID-19 related reduction in pediatric emergency healthcare utilization-a concerning trend Impacto de la pandemia COVID-19 en urgencias: primeros hallazgos en un hospital de Madrid Effects of COVID-19 pandemic on emergency medical services Delayed access or provision of care in Italy resulting from fear of COVID-19 Delayed cancer diagnoses and high mortality in children during the COVID-19 pandemic Coronavirus disease 2019 (COVID-19) in children-what we know so far and what we do not COVID-19: transatlantic declines in pediatric emergency admissions Collateral damage of the COVID-19 outbreak: expression of concern Trends in intensive neonatal care during the COVID-19 outbreak in Japan Suicide risk and prevention during the COVID-19 pandemic Suicide ideation and attempts in a Pediatric Emergency Department before and during COVID-19