Abstract
BackgroundItaly was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period.MethodsThe study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics.ResultsThe reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access.ConclusionsIn the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn’t demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.
Highlights
Since the outbreak of Coronavirus Disease 2019 (COVID19) in the city of Wuhan in China, in the early December 2019 the COVID-19, the pandemic has taken the world by storm and ravaged almost every country in the world
In the pandemic period there was a general reduction in the number of children referred to Emergency Department (ED), such reduction was greater in low-acuity levels
The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools
Summary
Since the outbreak of Coronavirus Disease 2019 (COVID19) in the city of Wuhan in China, in the early December 2019 the COVID-19, the pandemic has taken the world by storm and ravaged almost every country in the world. Was the first affected country in Europe, with the first person-to-person transmission diagnosed on February 20th 2020. Children are affected less frequently and with more benign disease compared to adults [3]; they are accounted for about 2.2% of the diagnosed cases in China [4], 2.4% in Australia [5], 2.3% in the United States [6, 7] and 3.3% in Norway [8]. Was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020.
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