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The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter.
Am J Emerg Med. 2021 May; 43:109-114.AJ

Abstract

BACKGROUND

The Bronx has the highest prevalence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening.

OBJECTIVES

To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019.

METHODS

Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 - July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared.

RESULTS

19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p < 0.0001) and minor medical problems (61% vs. 67%, p < 0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p < 0.0001), appendicitis (1% vs. 0.4%, p < 0.0001) and other surgical complaints (1% vs. 0.5%, p < 0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts.

CONCLUSION

The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted.

Authors+Show Affiliations

Division of Pediatric Emergency Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States of America. Electronic address: rlevene@montefiore.org.Division of Pediatric Emergency Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States of America.Division of Academic General Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States of America.Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, NY, United States of America.Division of Pediatric Emergency Medicine, The Children's Hospital at Montefiore, Bronx, NY, United States of America.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

33550101

Citation

Levene, Rachel, et al. "The Ongoing Impact of COVID-19 On Asthma and Pediatric Emergency Health-seeking Behavior in the Bronx, an Epicenter." The American Journal of Emergency Medicine, vol. 43, 2021, pp. 109-114.
Levene R, Fein DM, Silver EJ, et al. The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter. Am J Emerg Med. 2021;43:109-114.
Levene, R., Fein, D. M., Silver, E. J., Joels, J. R., & Khine, H. (2021). The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter. The American Journal of Emergency Medicine, 43, 109-114. https://doi.org/10.1016/j.ajem.2021.01.072
Levene R, et al. The Ongoing Impact of COVID-19 On Asthma and Pediatric Emergency Health-seeking Behavior in the Bronx, an Epicenter. Am J Emerg Med. 2021;43:109-114. PubMed PMID: 33550101.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter. AU - Levene,Rachel, AU - Fein,Daniel M, AU - Silver,Ellen J, AU - Joels,Joanna R, AU - Khine,Hnin, Y1 - 2021/01/28/ PY - 2020/12/29/received PY - 2021/01/22/revised PY - 2021/01/25/accepted PY - 2021/2/8/pubmed PY - 2021/5/12/medline PY - 2021/2/7/entrez KW - Asthma KW - COVID-19 KW - Epicenter KW - Pediatric emergency medicine SP - 109 EP - 114 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 43 N2 - BACKGROUND: The Bronx has the highest prevalence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening. OBJECTIVES: To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019. METHODS: Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 - July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared. RESULTS: 19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p < 0.0001) and minor medical problems (61% vs. 67%, p < 0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p < 0.0001), appendicitis (1% vs. 0.4%, p < 0.0001) and other surgical complaints (1% vs. 0.5%, p < 0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. CONCLUSION: The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/33550101/The_ongoing_impact_of_COVID_19_on_asthma_and_pediatric_emergency_health_seeking_behavior_in_the_Bronx_an_epicenter_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(21)00075-9 DB - PRIME DP - Unbound Medicine ER -