Pediatr Emerg Med J.  2024 Jul;11(3):107-114. 10.22470/pemj.2024.00976.

Changes in emergency department utilization by neonates during the coronavirus disease 2019 pandemic: a single-center study in Korea

• Lee SH
• Yoon SW
• Jin JH

• KMID: 2557048
• DOI: http://doi.org/10.22470/pemj.2024.00976

Abstract

Purpose
This study describes changes in the utilization pattern of emergency departments (EDs) by neonates during the coronavirus disease 2019 pandemic to ensure efficient resource allocation during future infectious disease outbreaks.
Methods
We performed a retrospective observational study by reviewing the medical records of neonates (≤ 30 days) who visited the ED. They were divided into pre-pandemic (February 2018-January 2020) and pandemic (February 2020-January 2022) groups. We compared data regarding ED utilization, including length of stay, disposition, and chief complaints.
Results
A total of 156 neonates visited the ED during the study period. A 42.4% decrease in the visits was observed during the pandemic group (n = 57), compared with the pre-pandemic group (n = 99). In particular, the proportion of visits by neonates aged 7 days or younger has decreased from 14.1% (14/99) to 3.5% (2/57; P = 0.035). The proportion of plain radiography performed and median ED length of stay increased from 36.4% (36/99) to 63.2% (36/57; P = 0.001), and from 66.0 minutes (interquartile range, 42.0-116.0) to 86.0 minutes (59.0-153.0; P = 0.007), respectively. Among the chief complaints, fever, respiratory symptoms, and minor clinical problems increased during the pandemic (29.3% to 36.8%, 11.1% to 14.0%, and 9.1% to 14.0%, respectively).
Conclusion
The pandemic led to a marked reduction in neonatal ED visits, particularly among those aged 7 days or younger. Increases were noted in the rates of plain radiography performed, fever, respiratory, and minor clinical symptoms, as well as median ED length of stay. EDs should prepare for efficient emergency treatments tailored to neonates.

Keyword

Coronavirus; COVID-19; Emergency service, Hospital; Infant, Newborn; Pediatric Emergency Medicine; Pediatrics

Reference

References

1. Infectious Disease Portal (Korea). COVID-19 positive cases (samples) monitoring status [Internet]. Korea Disease Control and Prevention Agency; 2023 [cited 2024 Apr 1]. Available from: https://dportal.kdca.go.kr/pot/cv/trend/dmstc/selectMntrgSttus.do. Korean.

2. Lucero AD, Lee A, Hyun J, Lee C, Kahwaji C, Miller G, et al. Underutilization of the emergency eepartment euring the COVID-19 pandemic. West J Emerg Med. 2020; 21:15–23.

3. Choi DH, Jung JY, Suh D, Choi JY, Lee SU, Choi YJ, et al. Impact of the COVID-19 outbreak on trends in emergency department utilization in children: a multicenter retrospective observational study in Seoul Metropolitan Area, Korea. J Korean Med Sci. 2021; 36:e44.

4. Pines JM, Zocchi MS, Black BS, Carlson JN, Celedon P, Moghtaderi A, et al. Characterizing pediatric emergency department visits during the COVID-19 pandemic. Am J Emerg Med. 2021; 41:201–4.

5. Batu ED, Yeni S, Teksam O. The factors affecting neonatal presentations to the pediatric emergency department. J Emerg Med. 2015; 48:542–7.

6. Ferreira H, Ferreira C, Tavares C, Aguiar I. Why are newborns brought to the emergency department? Pediatr Emerg Care. 2018; 34:883–7.

7. Lim T, Park J, Je S. Pediatric Korean Triage and Acuity Scale. Pediatr Emerg Med J. 2015; 2:53–8. Korean.

8. Hwang Y, Jo HY, Yoo HW, Kim YM, Kim HY. Characteristics of children with trauma compared to those with disease in the emergency department: a Korean single regional emergency medical center study. Pediatr Emerg Med J. 2020; 7:108–13. Korean.

9. Lee KJ, Park MH, Suh J, Jung SY, Lee SJ, Cha M. Triage results of children who visited the emergency department via emergency medical service providers: an observational study in a regional emergency medical center. Pediatr Emerg Med J. 2017; 4:18–24. Korean.

10. Agency for Healthcare Research and Quality (AHRQ). Clinical classifications software refined (CCSR) for ICD-10-CM diagnoses [Internet]. AHRQ; 2023 [2024 Feb 26]. Available from: https://hcup-us.ahrq.gov/toolssoftware/ccsr/dxccsr.jsp#overview.

11. Bhopal SS, Bagaria J, Olabi B, Bhopal R. Children and young people remain at low risk of COVID-19 mortality. Lancet Child Adolesc Health. 2021; 5:e12–3.

12. Sisk B, Cull W, Harris JM, Rothenburger A, Olson L. National trends of cases of COVID-19 in children based on US State health department data. Pediatrics. 2020; 146:e2020027425.

13. Kim HM, Ha SO, Yang WS, Park YS, Kim JH. Effect of coronavirus disease 2019 pandemic on children’s visits to the emergency department. Pediatr Emerg Med J. 2022; 9:10–6.

14. Hwang SY, Lee JK, Ryu HS, Park SS, Choi JY, Lee HJ, et al. Long-term impact of coronavirus disease 2019 pandemic on emergency department utilization in a metropolitan emergency department in Korea. Pediatr Emerg Med J. 2021; 8:57–65. Korean.

15. Silvagni D, Baggio L, Lo Tartaro Meragliotta P, Soloni P, La Fauci G, Bovo C, et al. Neonatal and pediatric emergency room visits in a tertiary center during the COVID-19 pandemic in Italy. Pediatr Rep. 2021; 13:168–76.

16. Masler IV, Shah N, Duerring SA, Monroe KR. Effects of the COVID-19 pandemic on the pediatric emergency department: a single institution experience. Inj Epidemiol. 2022; 9(Suppl 1):34.

17. Lee B, Chang I, Kim DK, Park JD; Korean Society of Pediatric Emergency Medicine. Factors associated with triage modifications using vital signs in pediatric triage: a nationwide cross-sectional study in Korea. J Korean Med Sci. 2020; 35:e102.

18. Oh WC, Noh H. Consideration in Korean Triage and Acuity Scale for febrile pediatric patients: symptom duration. Korean Soc Emerg Med. 2019; 30:69–76.

19. Haddadin Z, Blozinski A, Fernandez K, Vittetoe K, Greeno AL, Halasa NB, Lovvorn HN 3rd. Changes in pediatric emergency department visits during the COVID-19 pandemic. Hosp Pediatr. 2021; 11:e57–60.

20. Davis J, Lehman E. Fever characteristics and risk of serious bacterial infection in febrile infants. J Emerg Med. 2019; 57:306–13.

21. Donovan EF, Perlstein PH, Atherton HD, Kotagal UR. Prenatal care and infant emergency department use. Pediatr Emerg Care. 2000; 16:156–9.

22. Lee HC, Bardach NS, Maselli JH, Gonzales R. Emergency department visits in the neonatal period in the United States. Pediatr Emerg Care. 2014; 30:315–8.