Six Diagnoses of Separation: Impact of COVID-19 on Pediatric Emergency Department Visits: A Multicenter Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) arrived in the New York metropolitan area in early March 2020. Recommendations were made to self-quarantine within households and limit outside visits, including those to clinics and hospitals, to limit the spread of the virus. This resulted in a decrease in pediatric emergency department (ED) visits. However, it is unclear how this affected visits for some common diagnoses such as anxiety, appendicitis, asthma, headaches, seizures, and urinary tract infection (UTI). These diagnoses were chosen a priori, as they were felt to represent visits to the ED, for which the diagnoses would likely not be altered based on COVID exposure or quarantine due to their acute nature. OBJECTIVES: Our goal was to investigate the effect of COVID-19 on common pediatric diagnoses seen in the pediatric ED using a large multihospital database. METHODS: We conducted a retrospective cohort study of consecutive pediatric patients (age ≤ 21 years) between March 1 and November 30 in 2019 and 2020 in 28 hospital EDs within 150 miles of New York City. We compared the change in the number of visits from 2019 to 2020 for the following diagnoses: anxiety, appendicitis, asthma, headache, seizures, and UTI. RESULTS: Our database contained 346,230 total pediatric visits. From 2019 to 2020, total visits decreased by 61%. Decreases for specific diagnoses were 75% for asthma, 64% for headaches, 47% for UTI, 32% for anxiety, 28% for seizures, and 18% for appendicitis (p value for each comparison < 0.0001). CONCLUSIONS: We found a marked decrease in ED visits for six common pediatric diagnoses after COVID-19 arrived in our area. We suspect that this decrease was due to recommendations to quarantine and fear of contracting the virus. Further studies on other diagnoses and potential complications due to the delay in seeking care are needed.

Rise in emergency department visits of pediatric patients for renal colic from 1999 to 2008.

OBJECTIVE: Renal colic has been considered predominantly a disease of adults with only occasional cases occurring in the pediatric population. A recent report from a single hospital showed a rise in the number of children with renal colic. Our objective was to examine this in a much larger multihospital database of emergency department (ED) visits. METHODS: This study has a retrospective cohort design. It was conducted on consecutive pediatric patients (age <18 years) with a diagnosis of "renal colic, calculus kidney, calculus ureter, urinary calculus, or urethral calculus" according to the International Classification of Diseases, Ninth Revision, as seen by ED physicians in 29 urban, suburban, and rural EDs in New Jersey and New York between January 1, 1999, and December 31, 2008. We analyzed the number of renal colic visits as a percent of total ED pediatric visits in yearly intervals using the Student t test and performed a regression analysis. The α was set at 0.05. RESULTS: The database contained 6,497,458 total ED visits, of which 1,312,487 (20%) were pediatric visits. Of these, 1005 (0.077%) were for renal colic. The median age of these pediatric patients was 16 years (interquartile range, 13-17 years) and 61% were female. The percentage of ED pediatric visits for renal colic increased from 0.048% in 1999 to 0.089% in 2008, an increase of 86% (95% confidence interval, 36%-154%; P < 0.001). The correlation coefficient for this upward trend was R2 = 0.69 (P = 0.003). CONCLUSIONS: We found a marked increase in ED pediatric visits for renal colic over the past decade. This may reflect a real increase in the incidence of renal colic in the pediatric population or an increased use of imaging modalities for abdominal and flank pain.

Cutaneous methicillin-resistant Staphylococcus aureus in a suburban community hospital pediatric emergency department.

BACKGROUND: Studies on methicillin-resistant Staphylococcus aureus (MRSA) infections have typically focused on pediatric and adult populations at urban tertiary care hospitals. Limited data exist on MRSA rates in skin and soft tissue infections (SSTI) in suburban community hospital pediatric emergency departments (PED). OBJECTIVES: To describe the prevalence of MRSA in SSTIs in a contemporary suburban community hospital PED population. METHODS: Patients 0-21 years old with SSTI wound cultures who were seen at our PED from 2003-2007 were studied. Data analyzed included type of infection (abscess vs. non-abscess), site of infection, and culture results. Chi-squared and t-tests were used as appropriate; p < 0.05 was considered significant. RESULTS: During the study period, 204 cultures were obtained for SSTIs, 11 of which were contaminants. The subjects had a mean age of 12.9 years (SD 6.8 years); 60% were male. The prevalence of MRSA was 27%; MRSA was present in 30% of abscesses vs. 2.2% of non-abscess SSTI (p < 0.005). By year, the prevalence of MRSA was 10% in 2003, 31% in 2004, 33% in 2005, 31% in 2006, and 29% in 2007. No differences between MRSA and non-MRSA infections were present for gender, age, or site of infection. CONCLUSIONS: At our suburban community hospital pediatric ED, MRSA was present in 30% of all SSTI wound cultures; MRSA was unlikely with non-abscess SSTI. Our overall MRSA prevalence data among SSTIs are consistent with previously published reports in pediatric ED populations but may be less than those reported in the adult literature.

Impact of outpatient SARS-CoV-2 infections in minority children.

ABSTRACT: Data regarding COVID-19 in the adult population and hospitalized children is rapidly evolving, but little is known about children infected with severe acute respiratory syndrome coronavirus 2 who do not require hospitalization.In an observational, retrospective study we analyzed risk factors, demographics and clinical course of non-hospitalized patients ≤ 21 years of age with COVID-19 infection.Of the 1,796 patients evaluated, 170 were infected, and 40 participated in a telephone survey. Children older >10 years of age (OR: 2.19), Hispanic ethnicity (OR: 3) and residing in counties with higher rates of poverty (OR: 1.5) were associated with higher risk of infection, while older girls were more likely to experience prolonged duration of symptoms (median: 32 days). Consistent with prior reports, fever and cough were present in most of our patients. Shortness of breath, diarrhea, anosmia, and ageusia were more common in our outpatient population than previously reported.Larger studies addressing the clinical and psychosocial impact of CoVID-19 infection in children living in high-risk environments are warranted.

Diagnosis of pediatric intussusception by an emergency physician-performed bedside ultrasound: a case report.

The past decade has seen a rapid evolution in the use of bedside ultrasound (BUS) in the emergency department (ED). In addition, it has been increasingly used in the pediatric population for a variety of indications. As ED BUS is a relatively new modality in pediatric emergency medicine, novel indications are increasingly being recognized. We report a case of a 9-month-old infant who presented with signs and symptoms suggestive of intussusception, whose diagnosis was made using ED BUS in the pediatric ED. Knowledge of the sonographic appearance of intussusception can aid the emergency physician in the prompt diagnosis of this condition while potentially minimizing complications that may result from a delay in diagnosis.