ED visits by children declined early in pandemic

While the number of visits to one ED declined overall among children in the early months of the pandemic, the proportion of trauma-related visits increased significantly, researchers reported.

Zaid Haddadin, MD, a postdoctoral research fellow at Vanderbilt University Medical Center, and colleagues conducted a 3-year single-center retrospective study from 2018 to 2020. Their study included children aged 18 years or younger who presented to the ED for either acute respiratory illness or trauma between March 1 and May 31 of each year.

According to the researchers, throughout the 3-month period, the total pediatric ED visits that occurred in 2020 were 6,393, compared with 11,758 in 2018 and 12,138 in 2019.

The total number of visits related to acute respiratory illness decreased by 58% in 2020, while the frequency decreased as well, likely because of social distancing measures or as a result of “changes in health care-seeking behaviors and limited access to care during the pandemic,” Haddadin and colleagues wrote.

ED visits related to trauma decreased overall by 34% in 2020 — likely due to reduced driving, traffic and after-school activities, the researchers said — although the proportion of trauma-related ED visits increased to 26%, compared with 21% and 22% in 2018 and 2019, respectively.

The authors said the cumulative proportion of trauma relative to acute respiratory illness increased significantly in 2020, following a “safer-at-home” order. Also, an increase in the number and proportion of trauma-related visits related to recreational vehicle activities occurred.

However, the numbers and proportions of intentional injuries — nonaccidental trauma (NAT), abuse, suicide, assault/homicide — decreased, as did animal-related injuries, the researchers reported.

The researchers reported that the numbers of injuries from NAT or abuse, suicide, and assault or homicides declined significantly in 2020, “likely resulting from the presence of multiple caregivers in the home with increased supervision, which also plausibly explains the decreases in animal-related injuries (eg, animal bites) in our study.”

“Contrarily, data have shown decreases in health care and ED visits among children during the pandemic, and the decreases in NAT/abuse might be a reflection of decreased presentation rather than true declines, given that teachers and other school staff are often instrumental in bringing these concerns to attention in a timely manner, and closure of schools maybe have contributed to reduced detection and delayed presentation of NAT/abuse, which our study would not have captured given the time-window chosen,” they wrote.

“Nevertheless,” they continued, “we do believe that multiple adults mandated to be home at the same time have contributed to a reduction in the overall intentional and animal-related injuries together through better supervision of young children.”