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Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study.
Arch Dis Child. 2021 09; 106(9):911-917.AD

Abstract

OBJECTIVES

To determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on 23 March 2020.

DESIGN

National retrospective cohort study.

SETTING

Emergency childhood primary and secondary care providers across Scotland; two national paediatric intensive care units (PICUs); statutory death records.

PARTICIPANTS

273 455 unscheduled primary care attendances; 462 437 emergency department attendances; 54 076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years.

MAIN OUTCOME MEASURES

Rates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all data sets, rates during the lockdown period were compared with mean or aggregated rates for the equivalent dates in 2016-2019.

RESULTS

The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell as a proportion of cases for the entire population, with an OR of 0.52 for likelihood of admission during lockdown (95% CI 0.37 to 0.73), compared with the equivalent period in previous years. Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared with 2016-2019.

CONCLUSIONS

National lockdown led to a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.

Authors+Show Affiliations

Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.Usher Institute, The University of Edinburgh, Edinburgh, UK.Department of Child Life and Health, The University of Edinburgh, Edinburgh, UK. Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK.Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK. Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK.Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK.Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK.Critical Care, Royal Hospital for Children, Glasgow, UK.Critical Care, Royal Hospital for Children, Glasgow, UK.Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK. Critical Care, Royal Hospital for Sick Children, Edinburgh, UK.Critical Care, Royal Hospital for Sick Children, Edinburgh, UK.Critical Care, Royal Hospital for Sick Children, Edinburgh, UK.Critical Care, Royal Hospital for Children, Glasgow, UK.Department of Child Health, University of Aberdeen, Aberdeen, UK.Critical Care, Royal Hospital for Sick Children, Edinburgh, UK.Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK. Department of Child Life and Health, The University of Edinburgh, Edinburgh, UK.Usher Institute, The University of Edinburgh, Edinburgh, UK.Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK ross.langley@ggc.scot.nhs.uk.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33451994

Citation

Williams, Thomas C., et al. "Indirect Effects of the COVID-19 Pandemic On Paediatric Healthcare Use and Severe Disease: a Retrospective National Cohort Study." Archives of Disease in Childhood, vol. 106, no. 9, 2021, pp. 911-917.
Williams TC, MacRae C, Swann OV, et al. Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study. Arch Dis Child. 2021;106(9):911-917.
Williams, T. C., MacRae, C., Swann, O. V., Haseeb, H., Cunningham, S., Davies, P., Gibson, N., Lamb, C., Levin, R., McDougall, C. M., McFadzean, J., Piper, I., Turner, A., Turner, S. W., Van Dijke, M., Urquhart, D. S., Guthrie, B., & Langley, R. J. (2021). Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study. Archives of Disease in Childhood, 106(9), 911-917. https://doi.org/10.1136/archdischild-2020-321008
Williams TC, et al. Indirect Effects of the COVID-19 Pandemic On Paediatric Healthcare Use and Severe Disease: a Retrospective National Cohort Study. Arch Dis Child. 2021;106(9):911-917. PubMed PMID: 33451994.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study. AU - Williams,Thomas C, AU - MacRae,Clare, AU - Swann,Olivia V, AU - Haseeb,Haris, AU - Cunningham,Steve, AU - Davies,Philip, AU - Gibson,Neil, AU - Lamb,Christopher, AU - Levin,Richard, AU - McDougall,Catherine M, AU - McFadzean,Jillian, AU - Piper,Ian, AU - Turner,Alastair, AU - Turner,Stephen W, AU - Van Dijke,Margrethe, AU - Urquhart,Donald S, AU - Guthrie,Bruce, AU - Langley,Ross J, Y1 - 2021/01/15/ PY - 2020/10/21/received PY - 2020/12/24/revised PY - 2020/12/28/accepted PY - 2021/1/17/pubmed PY - 2021/8/31/medline PY - 2021/1/16/entrez KW - COVID-19 KW - epidemiology KW - mortality SP - 911 EP - 917 JF - Archives of disease in childhood JO - Arch Dis Child VL - 106 IS - 9 N2 - OBJECTIVES: To determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on 23 March 2020. DESIGN: National retrospective cohort study. SETTING: Emergency childhood primary and secondary care providers across Scotland; two national paediatric intensive care units (PICUs); statutory death records. PARTICIPANTS: 273 455 unscheduled primary care attendances; 462 437 emergency department attendances; 54 076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years. MAIN OUTCOME MEASURES: Rates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all data sets, rates during the lockdown period were compared with mean or aggregated rates for the equivalent dates in 2016-2019. RESULTS: The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell as a proportion of cases for the entire population, with an OR of 0.52 for likelihood of admission during lockdown (95% CI 0.37 to 0.73), compared with the equivalent period in previous years. Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared with 2016-2019. CONCLUSIONS: National lockdown led to a reduction in paediatric emergency care utilisation, without associated evidence of severe harm. SN - 1468-2044 UR - https://www.unboundmedicine.com/medline/citation/33451994/Indirect_effects_of_the_COVID_19_pandemic_on_paediatric_healthcare_use_and_severe_disease:_a_retrospective_national_cohort_study_ L2 - https://adc.bmj.com/lookup/pmidlookup?view=long&pmid=33451994 DB - PRIME DP - Unbound Medicine ER -