Abstract

Before the COVID pandemic, the Pediatric Emergency Department (ED) had been experiencing a progressive overload due to an increasing of visits, but this high demand for emergency pediatric care does not always translate into serious conditions requiring hospital attendance. Frequent users, defined has having eleven or more admissions per year, are often associated with inadequate emergency visits. We performed a retrospective study of admissions to a Portuguese pediatric ED during the year of 2018, and we described the characteristics of its frequent users. The aim of this study was to compare the utilization of ED by the frequent users throughout 2018 and during the first year of the COVID-19 pandemic. In 2018, we identified 123 frequent users representing 1% of the patients that sought ED care and accounting for more than 5% of the total visits. In 2020, during the first year of the pandemic (from March 1^st, 2020, to February 28^th, 2021) we observed a significant reduction in all ED visits, as well as frequent users. The average age of patients changed significantly in the two periods (2,44 vs 4,65; p 0,000), with no gender differences. In both years, most children didn´t have a relevant pre-existing medical condition, but 45,5% frequent users in 2018 had a least one previous hospitalization, compared to just 26,5% of the frequent users in 2020 (p < 0,05).

To our knowledge, these are the first data on frequent user’s attendance during the pandemic compared to what happened previously. And if before we had a population of small children with inexperienced parents that don´t make the correct use of primary care, during the pandemic, anxiety and psychosomatic symptoms were predominant.

Keywords: Emergency Department; Frequent Users; Pediatrics

References

1. Pérez S., et al. “Frecuentación a los servicios de urgências hospitalarios: motivaciones y características de las urgencias pediátricas”. Anales Españoles de Pediatria 2 (1996): 97-104.
2. Vilarinho L., et al. “Programa Nacional de Diagnóstico Precoce. Relatório 2018”. Comissão Executiva do Programa Nacional de Diagnóstico Precoce. Instituto Nacional de Saúde Doutor Ricardo Jorge (2019).
3. Supat B., et al. “Characterizing pediatric high frequency users of California emergency departments”. American Journal of Emergency Medicine 37 (2019): 1699-1704.
4. Neuman MI., et al. “Characteristics of Recurrent Utilization in Pediatric Emergency Departments. Pediatrics”. Pediatrics4 (2014): 1025-1031.
5. Maugein L., et al. “Consultations itératives aux urgencies pédiatriques”. Archives de Pédiatrie 2 (2011): 128-134.
6. Seguin J., et al. “Frequent users of the pediatric emergency department”. Canadian Journal of Emergency Medicine 3 (2017): 401-408.
7. Yamamoto LG., et al. “Characteristics of frequent pediatric emergency department users”. Pediatric Emergency Care6 (1995): 340-356.
8. Goldman RD, Kissoon N. “An epidemic we must address”. Canadian Journal of Emergency Medicine4 (2018): 493-494.
9. Kruizing MD, et al”. The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature”. European Journal of Pediatrics7 (2021): 2271-2279.
10. Garcia AR., et al. “Frequent users in peadiatric emergency departments. Who are they? Why do they consult?” Anales de Pedíatria (Barc)2 (2017): 67-75.
11. Alpern ER., et al. “Recurrent and High-frequency Use of the Emergency Department by Pediatric Patients”. Academic Emergency Medicine4 (2014): 365-372.
12. Nascimento C. “Utilizadores Frequentes Do Serviço de Urgência Pediátrico. Mito ou Realidade”. Mestrado Integrado em Informática Médica da Faculdade de Ciências da Universidade do Porto (2017).
13. Oliveira A., et al. “Serviço de Urgência Pediátrico: casuística de um hospital com serviço de Pediatria Geral”. Saúde Infantil2 (2010): 53-58.
14. Martínez RQ., et al. “Padecimientos más frecuentemente atendidos en el Servicio de Urgencias Pediátricas en un hospital de tercer nível”. Revista de la Facultad de Medicina, Universidad Nacional Autónoma de México 51.1 (2008): 5-10.
15. Armentia SLL., et al. “Estudio epidemiológico de las urgencias pediátricas en un hospital general. Factores implicados en una demanda inadecuada”. Anales Españoles de Pediatria2 (1996): 121-125.
16. Isba R., et al. “Where have all the children gone? Decreases in Paediatric emergency department attendances at the start of the COVID-19 pandemic of 2020”. Archives of Disease in Childhood1 (2020).
17. Clavena A., et al. “Impact of COVID-19 on the Pattern of Access to a Pediatric Emergency Department in the Lombardy Region, Italy”. Pediatric Emergency Care10 (2020).
18. Hoge MA., et al. “Emergency used by children and youth with mental health conditions: a health equity agenda”. Community Mental Health Journal (2022).
19. Valitutti F., et al. “Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19”. Frontiers in Pediatrics 8 (2020): 521.

Citation

Citation: Teresa Pinheiro., et al. “Characterization of Frequent Users of a Pediatric Emergency Department in Level II Hospital and What Changed with the COVID Pandemic". Acta Scientific Paediatrics 5.5 (2022): 42-48.

Copyright

Copyright: © 2022 Teresa Pinheiro., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.