Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore
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RESEARCH ARTICLE
Open Access
Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore Shu-Ling Chong1,2* , Jenifer Shui Lian Soo3, John Carson Allen Jr4, Sashikumar Ganapathy1,2, Khai Pin Lee1,2, Arif Tyebally1,2, Chee Fu Yung2,5, Koh Cheng Thoon2,3, Yong Hong Ng2,3, Jean Yin Oh2,6, Oon Hoe Teoh2,6, Yee Hui Mok2,7 and Yoke Hwee Chan2,3
Abstract Background: Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore. Methods: We performed a retrospective review of ED attendances and hospital admissions among children < 18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs). Results: We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline (p < 0.001), attributed largely to a drop in respiratory (% change − 87.9, 95% CI − 89.3 to − 86.3, p < 0.001) and gastrointestinal infections (% change − 72.4, 95%CI − 75.9 to − 68.4, p < 0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change − 40.0, 95%CI − 44.3 to − 35.3, p < 0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p < 0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change − 73.9, 95%CI − 75.9 to − 71.7, p < 0.001). Conclusions: We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics. Keywords: COVID-19, Child, Health services, Resource utilization
* Correspondence: [email protected] 1 Department of Emergency Medicine, KK Women’s and Children’s Hospital, 100, Bukit Timah Road, Singapore 229899, Singapore 2 Duke-NUS Medical School, Singapore, Singapore Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in
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