Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network
Abstract Background The COVID‐19 pandemic affected the volume and epidemiology of pediatric emergency department (ED) visits. We aimed to determine the rate of associated complications for 16 high‐risk conditions in a Michigan statewide network of academic and community EDs during the pandemic. Meth...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12865 |
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| author | Courtney W. Mangus Sarah J. Parker Amy M. DeLaroche Xingyu Zhang Stephen Gunnink Julia Hayes Gerard Heath Erica Michiels Prashant Mahajan |
| author_facet | Courtney W. Mangus Sarah J. Parker Amy M. DeLaroche Xingyu Zhang Stephen Gunnink Julia Hayes Gerard Heath Erica Michiels Prashant Mahajan |
| author_sort | Courtney W. Mangus |
| collection | DOAJ |
| description | Abstract Background The COVID‐19 pandemic affected the volume and epidemiology of pediatric emergency department (ED) visits. We aimed to determine the rate of associated complications for 16 high‐risk conditions in a Michigan statewide network of academic and community EDs during the pandemic. Methods We conducted a cross‐sectional study of pediatric ED visits among a network of 5 Michigan health systems during the pre‐pandemic (March 1, 2019–March 10, 2020) and pandemic (March 11, 2020–March 31, 2021) periods. Data were collected from the medical record and included patient demographics, ED visit characteristics, procedure codes, and final International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. Selection of codes for 16 high‐risk conditions and diagnostic complications were identified using previously described methods. Characteristics of ED visits were compared before versus during the pandemic using χ2 and Fisher's exact tests. We used multilevel logistic regression to analyze covariates and potential confounders for being diagnosed with a high‐risk condition or a complication of a high‐risk condition. Results A total of 417,038 pediatric ED visits were analyzed. The proportion of patients presenting with 10 of 16 high‐risk conditions (including appendicitis, sepsis, and stroke) was higher in the pandemic period compared with pre‐pandemic (P < 0.01). Despite this, there was no significant increase in the frequency of complications for any of the 16 high‐risk conditions during the pandemic. The adjusted odds of being diagnosed with appendicitis (pre‐pandemic 0.23% vs pandemic 0.52%; odds ratio [OR], 1.19 [95% confidence interval, CI, 1.00–1.41]), diabetic ketoacidosis (pre‐pandemic 0.16% vs pandemic 0.52%; OR, 2.40 [95% CI, 2.07–2.78]), intussusception (pre‐pandemic 0.05% vs pandemic 0.07%; OR, 1.64 [95% CI, 1.22–2.21)], and testicular torsion (pre‐pandemic 0.10% vs pandemic 0.14%; OR, 1.64 [95% CI, 1.18–2.28]) was higher during the pandemic. Conclusions Despite a higher proportion of ED visits attributed to high‐risk conditions, there was no increase in complications, suggesting minimal impact of the pandemic on outcomes of pediatric ED visits. |
| format | Article |
| id | doaj-art-ba673070d497464ab9bafcba63f7037d |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-ba673070d497464ab9bafcba63f7037d2025-08-20T01:55:41ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522022-12-0136n/an/a10.1002/emp2.12865Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency networkCourtney W. Mangus0Sarah J. Parker1Amy M. DeLaroche2Xingyu Zhang3Stephen Gunnink4Julia Hayes5Gerard Heath6Erica Michiels7Prashant Mahajan8Department of Emergency Medicine University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Ann Arbor Michigan USADivision of Pediatric Emergency Medicine, Department of Pediatrics Children's Hospital of Michigan Detroit Michigan USAThomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania USADepartment of Emergency Medicine, Helen DeVos Children's Hospital Michigan State University College of Human Medicine Grand Rapids Michigan USADepartment of Emergency Medicine Henry Ford Hospital Detroit Michigan USADepartment of Emergency Medicine Henry Ford Hospital Detroit Michigan USADepartment of Emergency Medicine, Helen DeVos Children's Hospital Michigan State University College of Human Medicine Grand Rapids Michigan USADepartment of Emergency Medicine University of Michigan Ann Arbor Michigan USAAbstract Background The COVID‐19 pandemic affected the volume and epidemiology of pediatric emergency department (ED) visits. We aimed to determine the rate of associated complications for 16 high‐risk conditions in a Michigan statewide network of academic and community EDs during the pandemic. Methods We conducted a cross‐sectional study of pediatric ED visits among a network of 5 Michigan health systems during the pre‐pandemic (March 1, 2019–March 10, 2020) and pandemic (March 11, 2020–March 31, 2021) periods. Data were collected from the medical record and included patient demographics, ED visit characteristics, procedure codes, and final International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. Selection of codes for 16 high‐risk conditions and diagnostic complications were identified using previously described methods. Characteristics of ED visits were compared before versus during the pandemic using χ2 and Fisher's exact tests. We used multilevel logistic regression to analyze covariates and potential confounders for being diagnosed with a high‐risk condition or a complication of a high‐risk condition. Results A total of 417,038 pediatric ED visits were analyzed. The proportion of patients presenting with 10 of 16 high‐risk conditions (including appendicitis, sepsis, and stroke) was higher in the pandemic period compared with pre‐pandemic (P < 0.01). Despite this, there was no significant increase in the frequency of complications for any of the 16 high‐risk conditions during the pandemic. The adjusted odds of being diagnosed with appendicitis (pre‐pandemic 0.23% vs pandemic 0.52%; odds ratio [OR], 1.19 [95% confidence interval, CI, 1.00–1.41]), diabetic ketoacidosis (pre‐pandemic 0.16% vs pandemic 0.52%; OR, 2.40 [95% CI, 2.07–2.78]), intussusception (pre‐pandemic 0.05% vs pandemic 0.07%; OR, 1.64 [95% CI, 1.22–2.21)], and testicular torsion (pre‐pandemic 0.10% vs pandemic 0.14%; OR, 1.64 [95% CI, 1.18–2.28]) was higher during the pandemic. Conclusions Despite a higher proportion of ED visits attributed to high‐risk conditions, there was no increase in complications, suggesting minimal impact of the pandemic on outcomes of pediatric ED visits.https://doi.org/10.1002/emp2.12865COVID‐19diagnosispediatric emergency medicine |
| spellingShingle | Courtney W. Mangus Sarah J. Parker Amy M. DeLaroche Xingyu Zhang Stephen Gunnink Julia Hayes Gerard Heath Erica Michiels Prashant Mahajan Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network Journal of the American College of Emergency Physicians Open COVID‐19 diagnosis pediatric emergency medicine |
| title | Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network |
| title_full | Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network |
| title_fullStr | Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network |
| title_full_unstemmed | Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network |
| title_short | Impact of COVID‐19 on the associated complications of high‐risk conditions in a statewide pediatric emergency network |
| title_sort | impact of covid 19 on the associated complications of high risk conditions in a statewide pediatric emergency network |
| topic | COVID‐19 diagnosis pediatric emergency medicine |
| url | https://doi.org/10.1002/emp2.12865 |
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