COVID-19 大流行对儿科医疗保健利用和严重疾病的间接影响：一项回顾性全国队列研究。
Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study.
机构信息
Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.
Usher Institute, The University of Edinburgh, Edinburgh, UK.
出版信息
Arch Dis Child. 2021 Sep;106(9):911-917. doi: 10.1136/archdischild-2020-321008. Epub 2021 Jan 15.
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.
目的
在 2020 年 3 月 23 日封锁后，从全国层面上确定 COVID-19 大流行对儿科医疗保健利用和严重疾病的间接影响。
设计
全国回顾性队列研究。
设置
苏格兰各地的儿童初级和二级保健提供者；两个国家儿科重症监护病房（PICU）；法定死亡记录。
参与者
273455 次未计划的初级保健就诊；462437 次急诊就诊；54076 次急诊住院；413 例需要有创机械通气的 PICU 非计划急诊入院；以及封锁研究期间和前几年同期的 415 例死亡。
主要观察指标
急诊咨询、就诊和入院率；就诊至 PICU 时的临床严重程度评分；儿童死亡率和死因。对于所有数据集，封锁期间的发生率与 2016-2019 年同期的平均或综合发生率进行比较。
结果
与前几年相比，封锁期间儿童到初级和二级保健机构的急诊就诊率下降。需要有创机械通气的儿童紧急 PICU 入院率也有所下降，占总人口的比例为 0.52（95%CI 0.37 至 0.73），而前几年同期为 0.52。临床严重程度评分并未表明儿童的疾病更严重。PICU 入院率降幅最大的是呼吸系统疾病；而损伤、中毒或其他外部原因所致疾病与前几年持平。与 2016-2019 年相比，封锁期间的死亡率没有显著变化。
结论
全国性封锁导致儿科急诊就诊率下降，但没有严重伤害的相关证据。
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