TY - JOUR
T1 - Forecast modeling to identify changes in pediatric emergency department utilization during the COVID-19 pandemic
AU - Ramgopal, Sriram
AU - Pelletier, Jonathan H.
AU - Rakkar, Jaskaran
AU - Horvat, Christopher M.
N1 - Funding Information:
Dr. Pelletier is supported by grant 5T32HD040686-20 from the National Institutes of Health . Dr Rakker is supported by grant 5T32HD040686-19 from the National Institutes of Health . Dr Horvat is supported by grant 1K23HD099331-01A1 from National Institute of Child Health and Human Development . Dr. Ramgopal is supposed by PEDSnet (Department of Pediatrics; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago IL)
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Objective: To identify trends in pediatric emergency department (ED) utilization following the COVID-19 pandemic. Methods: We performed a cross-sectional study from 37 geographically diverse US children's hospitals. We included ED encounters between January 1, 2010 and December 31, 2020, transformed into time-series data. We constructed ensemble forecasting models of the most common presenting diagnoses and the most common diagnoses leading to admission, using data from 2010 through 2019. We then compared the most common presenting diagnoses and the most common diagnoses leading to admission in 2020 to the forecasts. Results: 29,787,815 encounters were included, of which 1,913,085 (6.4%) occurred during 2020. ED encounters during 2020 were lower compared to prior years, with a 65.1% decrease in April relative to 2010–2019. In forecasting models, encounters for depression and diabetic ketoacidosis remained within the 95% confidence interval [CI]; fever, bronchiolitis, hyperbilirubinemia, skin/subcutaneous infections and seizures occurred within the 80–95% CI during the portions of 2020, and all other diagnoses (abdominal pain, otitis media, asthma, pneumonia, trauma, upper respiratory tract infections, and urinary tract infections) occurred below the predicted 95% CI. Conclusion: Pediatric ED utilization has remained low following the COVID-19 pandemic, and below forecasted utilization for most diagnoses. Nearly all conditions demonstrated substantial declines below forecasted rates from the prior decade and which persisted through the end of the year. Some declines in non-communicable diseases may represent unmet healthcare needs among children. Further study is warranted to understand the impact of policies aimed at curbing pandemic disease on children.
AB - Objective: To identify trends in pediatric emergency department (ED) utilization following the COVID-19 pandemic. Methods: We performed a cross-sectional study from 37 geographically diverse US children's hospitals. We included ED encounters between January 1, 2010 and December 31, 2020, transformed into time-series data. We constructed ensemble forecasting models of the most common presenting diagnoses and the most common diagnoses leading to admission, using data from 2010 through 2019. We then compared the most common presenting diagnoses and the most common diagnoses leading to admission in 2020 to the forecasts. Results: 29,787,815 encounters were included, of which 1,913,085 (6.4%) occurred during 2020. ED encounters during 2020 were lower compared to prior years, with a 65.1% decrease in April relative to 2010–2019. In forecasting models, encounters for depression and diabetic ketoacidosis remained within the 95% confidence interval [CI]; fever, bronchiolitis, hyperbilirubinemia, skin/subcutaneous infections and seizures occurred within the 80–95% CI during the portions of 2020, and all other diagnoses (abdominal pain, otitis media, asthma, pneumonia, trauma, upper respiratory tract infections, and urinary tract infections) occurred below the predicted 95% CI. Conclusion: Pediatric ED utilization has remained low following the COVID-19 pandemic, and below forecasted utilization for most diagnoses. Nearly all conditions demonstrated substantial declines below forecasted rates from the prior decade and which persisted through the end of the year. Some declines in non-communicable diseases may represent unmet healthcare needs among children. Further study is warranted to understand the impact of policies aimed at curbing pandemic disease on children.
KW - COVID-19
KW - Delivery of health care
KW - Emergency service
KW - Hospital
KW - Hospitals
KW - Pediatric
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U2 - 10.1016/j.ajem.2021.05.047
DO - 10.1016/j.ajem.2021.05.047
M3 - Article
C2 - 34111834
AN - SCOPUS:85107438859
VL - 49
SP - 142
EP - 147
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
ER -