Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study

Thomas C Williams; Clare MacRae; Olivia Swann; Haris Haseeb; Steve Cunningham; Philip Davies; Neil Gibson; Christopher Lamb; Richard Levin; Catherine McDougall; Jillian McFadzean; Ian Piper; Alastair Turner; Steve Turner; Margrethe Van Dijke; Don Urquhart; Bruce Guthrie; Ross J Langley

doi:10.1101/2020.10.15.20212308

Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study

Thomas C Williams, Clare MacRae, Olivia Swann, Haris Haseeb, Steve Cunningham, Philip Davies, Neil Gibson, Christopher Lamb, Richard Levin, Catherine McDougall, Jillian McFadzean, Ian Piper, Alastair Turner, Steve Turner, Margrethe Van Dijke, Don Urquhart, Bruce Guthrie, Ross J Langley

Research output: Working paper › Preprint

Abstract

Background Severe disease directly associated with SARS-CoV-2 infection in children is rare. However, the indirect consequences of the COVID-19 pandemic on paediatric health have not been fully quantified. We examined paediatric health-care utilisation, incidence of severe disease, and mortality during the lockdown period in Scotland.

Methods This national retrospective cohort study examined national data for emergency childhood primary and secondary care utilisation following national lockdown on March 23, 2020. To determine whether social distancing measures and caregiver behavioural changes were associated with delayed care-seeking and increased disease severity on presentation, unplanned, emergency admissions requiring invasive mechanical ventilation for the two national Paediatric Intensive Care Units (PICUs) were analysed. PICU admissions were grouped by diagnostic category, and disease severity on presentation calculated. National statutory death records were consulted to establish childhood mortality rates and causes of death. For all observations, the lockdown period was compared to equivalent dates in 2016-2019.

Findings We identified 273,455 unscheduled primary care attendances; 462,437 emergency department attendances; 54,076 emergency hospital admissions; 413 PICU emergency admissions; and 415 deaths during the lockdown study period and equivalent dates in previous years. The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell, with an odds ratio of 0·52 for chance of admission during lockdown (95% CI 0·37-0·73, p < 0·001). Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared to 2016-2019.

Interpretation National lockdown led a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.

Original language	English
Publisher	medRxiv
DOIs	https://doi.org/10.1101/2020.10.15.20212308
Publication status	Published - 20 Oct 2020

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Williams, T. C., MacRae, C., Swann, O., Haseeb, H., Cunningham, S., Davies, P., Gibson, N., Lamb, C., Levin, R., McDougall, C., McFadzean, J., Piper, I., Turner, A., Turner, S., Dijke, M. V., Urquhart, D., Guthrie, B., & Langley, R. J. (2020). Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study. medRxiv. https://doi.org/10.1101/2020.10.15.20212308

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title = "Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study",

abstract = "Background Severe disease directly associated with SARS-CoV-2 infection in children is rare. However, the indirect consequences of the COVID-19 pandemic on paediatric health have not been fully quantified. We examined paediatric health-care utilisation, incidence of severe disease, and mortality during the lockdown period in Scotland.Methods This national retrospective cohort study examined national data for emergency childhood primary and secondary care utilisation following national lockdown on March 23, 2020. To determine whether social distancing measures and caregiver behavioural changes were associated with delayed care-seeking and increased disease severity on presentation, unplanned, emergency admissions requiring invasive mechanical ventilation for the two national Paediatric Intensive Care Units (PICUs) were analysed. PICU admissions were grouped by diagnostic category, and disease severity on presentation calculated. National statutory death records were consulted to establish childhood mortality rates and causes of death. For all observations, the lockdown period was compared to equivalent dates in 2016-2019.Findings We identified 273,455 unscheduled primary care attendances; 462,437 emergency department attendances; 54,076 emergency hospital admissions; 413 PICU emergency admissions; and 415 deaths during the lockdown study period and equivalent dates in previous years. The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell, with an odds ratio of 0·52 for chance of admission during lockdown (95% CI 0·37-0·73, p < 0·001). Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared to 2016-2019.Interpretation National lockdown led a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.",

author = "Williams, {Thomas C} and Clare MacRae and Olivia Swann and Haris Haseeb and Steve Cunningham and Philip Davies and Neil Gibson and Christopher Lamb and Richard Levin and Catherine McDougall and Jillian McFadzean and Ian Piper and Alastair Turner and Steve Turner and Dijke, {Margrethe Van} and Don Urquhart and Bruce Guthrie and Langley, {Ross J}",

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Williams, TC , MacRae, C , Swann, O, Haseeb, H, Cunningham, S, Davies, P, Gibson, N, Lamb, C, Levin, R, McDougall, C, McFadzean, J, Piper, I, Turner, A, Turner, S, Dijke, MV, Urquhart, D , Guthrie, B & Langley, RJ 2020 'Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study' medRxiv. https://doi.org/10.1101/2020.10.15.20212308

TY - UNPB

T1 - Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study

AU - Williams, Thomas C

AU - MacRae, Clare

AU - Swann, Olivia

AU - Haseeb, Haris

AU - Cunningham, Steve

AU - Davies, Philip

AU - Gibson, Neil

AU - Lamb, Christopher

AU - Levin, Richard

AU - McDougall, Catherine

AU - McFadzean, Jillian

AU - Piper, Ian

AU - Turner, Alastair

AU - Turner, Steve

AU - Dijke, Margrethe Van

AU - Urquhart, Don

AU - Guthrie, Bruce

AU - Langley, Ross J

PY - 2020/10/20

Y1 - 2020/10/20

N2 - Background Severe disease directly associated with SARS-CoV-2 infection in children is rare. However, the indirect consequences of the COVID-19 pandemic on paediatric health have not been fully quantified. We examined paediatric health-care utilisation, incidence of severe disease, and mortality during the lockdown period in Scotland.Methods This national retrospective cohort study examined national data for emergency childhood primary and secondary care utilisation following national lockdown on March 23, 2020. To determine whether social distancing measures and caregiver behavioural changes were associated with delayed care-seeking and increased disease severity on presentation, unplanned, emergency admissions requiring invasive mechanical ventilation for the two national Paediatric Intensive Care Units (PICUs) were analysed. PICU admissions were grouped by diagnostic category, and disease severity on presentation calculated. National statutory death records were consulted to establish childhood mortality rates and causes of death. For all observations, the lockdown period was compared to equivalent dates in 2016-2019.Findings We identified 273,455 unscheduled primary care attendances; 462,437 emergency department attendances; 54,076 emergency hospital admissions; 413 PICU emergency admissions; and 415 deaths during the lockdown study period and equivalent dates in previous years. The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell, with an odds ratio of 0·52 for chance of admission during lockdown (95% CI 0·37-0·73, p < 0·001). Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared to 2016-2019.Interpretation National lockdown led a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.

AB - Background Severe disease directly associated with SARS-CoV-2 infection in children is rare. However, the indirect consequences of the COVID-19 pandemic on paediatric health have not been fully quantified. We examined paediatric health-care utilisation, incidence of severe disease, and mortality during the lockdown period in Scotland.Methods This national retrospective cohort study examined national data for emergency childhood primary and secondary care utilisation following national lockdown on March 23, 2020. To determine whether social distancing measures and caregiver behavioural changes were associated with delayed care-seeking and increased disease severity on presentation, unplanned, emergency admissions requiring invasive mechanical ventilation for the two national Paediatric Intensive Care Units (PICUs) were analysed. PICU admissions were grouped by diagnostic category, and disease severity on presentation calculated. National statutory death records were consulted to establish childhood mortality rates and causes of death. For all observations, the lockdown period was compared to equivalent dates in 2016-2019.Findings We identified 273,455 unscheduled primary care attendances; 462,437 emergency department attendances; 54,076 emergency hospital admissions; 413 PICU emergency admissions; and 415 deaths during the lockdown study period and equivalent dates in previous years. The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell, with an odds ratio of 0·52 for chance of admission during lockdown (95% CI 0·37-0·73, p < 0·001). Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared to 2016-2019.Interpretation National lockdown led a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.

UR - https://doi.org/10.1101/2020.10.15.20212308

U2 - 10.1101/2020.10.15.20212308

DO - 10.1101/2020.10.15.20212308

M3 - Preprint

BT - Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study

PB - medRxiv

ER -

Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study

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Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study

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