Shaare Zedek Medical Center and the Faculty of Medicine at the Hebrew University in Jerusalem, Pediatric Emergency Department, Jerusalem, Israel.
Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
PLoS One. 2021 May 6;16(5):e0251003. doi: 10.1371/journal.pone.0251003. eCollection 2021.
The SARS-CoV-2 coronavirus pandemic may cause significant morbidity and mortality in adults, yet severe cases are rare among children. The indirect impact of the pandemic on health care delivery in general and pediatric emergency department (PED) visits in particular has been widely reported.
To assess the impact of the pandemic and the social restrictions imposed in its wake on PED visits and hospitalization rates in our Israeli medical center. We also sought to track these data in relation to the variation in pandemic severity and social restrictions over time. A comparison of this data with that of the adult emergency department was also performed.
Data for this study were drawn from the Shaare Zedek Medical Center (SZMC), Jerusalem, Israel computerized databank. The daily number of PED and adult ER visits as well as hospitalizations resulting from these visits during the months January-July during the years 2018, 2019, 2020 were recorded. We compared the risk ratio for hospitalization in 2019 and 2020, as well as the incidence rate ratio.
During March and April there was a decrease in PED visits from 4,588 visits in 2019 to 2,527 visits in 2020 (ratio = .551, 95%CI [.52,.58]. Despite the drop in PED visits, the rate of hospitalizations rose with respect to 2019 (Risk Ratio = 1.31, p < .001, 95%CI [1.17,1.47]). Similar but more moderate trends were seen in the adult ED. From May-July 2020, after the lockdown was lifted, PED visits remained 30% below the same time period from 2018 and 2019, while the hospitalization rate returned to its pre-pandemic level.
A significant drop in PED visits is seen to extend well beyond the peak of the pandemic and the lockdown period. This highlights the potential risk of children with serious emergencies becoming casualties of the pandemic by their not being brought to medical attention. Efforts should be made to raise public awareness among parents and other caretakers of children regarding this matter.
SARS-CoV-2 冠状病毒大流行可能导致成年人出现大量发病率和死亡率，但儿童中严重病例罕见。大流行对医疗保健服务的间接影响，尤其是对儿科急诊部门（PED）就诊的影响，已被广泛报道。
评估大流行及其后续实施的社会限制对我们以色列医疗中心 PED 就诊和住院率的影响。我们还试图追踪这些数据与大流行严重程度和随时间推移的社会限制变化的关系。还对这些数据与成人急诊部门的数据进行了比较。
本研究的数据来自耶路撒冷 Shaare Zedek 医疗中心（SZMC）的计算机数据库。记录了 2018 年、2019 年和 2020 年 1 月至 7 月期间，PED 和成人急诊室的每日就诊人数以及由此就诊导致的住院人数。我们比较了 2019 年和 2020 年的住院风险比以及发病率比。
在 3 月和 4 月，PED 就诊次数从 2019 年的 4588 次减少到 2020 年的 2527 次（比值=0.551，95%CI[0.52,0.58]）。尽管 PED 就诊次数下降，但与 2019 年相比，住院率上升（风险比=1.31，p<0.001，95%CI[1.17,1.47]）。成人急诊室也出现了类似但更为温和的趋势。2020 年 5 月至 7 月，封锁解除后，PED 就诊次数仍比 2018 年和 2019 年同期低 30%，而住院率则恢复到大流行前水平。
PED 就诊次数的显著下降不仅持续到大流行和封锁期的高峰期，而且还在持续。这突显出，因未能得到医疗关注，儿童中患有严重急症的儿童可能成为大流行的受害者。应努力提高家长和其他儿童看护者对此事的公众意识。
