Division of Pediatric Emergency Medicine, 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.
Am J Emerg Med. 2021 May;43:109-114. doi: 10.1016/j.ajem.2021.01.072. Epub 2021 Jan 28.
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.
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.
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.
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.
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.
布朗克斯区是美国（美国）哮喘发病率最高的地区，也是 COVID-19 的早期中心，因此成为一个独特的研究地点。全球报告描述了 COVID-19 期间儿科急诊部（PED）就诊量的显著下降。在大流行高峰期之外，以及在纽约州（NY）逐步重新开放的早期阶段，COVID-19 对所有 PED 就诊情况（包括哮喘）的持续影响尚未得到研究。
比较 2020 年大流行期间和随后纽约州（NY）分阶段重新开放初期与 2019 年同期 PED 健康寻求行为和临床特征。
回顾性分析 2020 年 3 月 15 日至 2020 年 7 月 6 日在纽约布朗克斯一家高容量四级儿童医院利用 PED 的 <21 岁儿童的图表，（大流行队列）和 2019 年同期（比较队列）。就诊被分配到预先确定的诊断类别。比较人口统计学和临床数据。
共纳入 19981 例就诊。2020 年就诊量下降了 66%。哮喘就诊比例（2%对 7%，p<0.0001）和轻度医疗问题（61%对 67%，p<0.0001）在大流行队列中显著下降，而严重医疗问题（13%对 8%，p<0.0001）、阑尾炎（1%对 0.4%，p<0.0001）和其他手术投诉（1%对 0.5%，p<0.0001）在大流行队列中比例增加。在两个队列中，心理社会和创伤组之间没有观察到显著的比例变化。
大流行队列的 PED 量大幅减少，但严重程度和入院率增加，在纽约州（NY）阶段-II 重新开放期间持续存在。尽管位于哮喘中心，但大流行队列中哮喘相关 PED 就诊的发生率明显下降。需要进一步研究室内过敏原单独对儿童哮喘的影响。
