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1. Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study.

Author

Ruud G Nijman, Kate Honeyford, Ruth Farrugia, Katy Rose, Zsolt Bognar, Danilo Buonsenso, Liviana Da Dalt, Tisham De, Ian K Maconochie, Niccolo Parri, Damian Roland, Tobias Alfven, Camille Aupiais, Michael Barrett, Romain Basmaci, Dorine Borensztajn, Susana Castanhinha, Corinne Vasilico, Sheena Durnin, Paddy Fitzpatrick, Laszlo Fodor, Borja Gomez, Susanne Greber-Platzer, Romain Guedj, Stuart Hartshorn, Florian Hey, Lina Jankauskaite, Daniela Kohlfuerst, Mojca Kolnik, Mark D Lyttle, Patrícia Mação, Maria Inês Mascarenhas, Shrouk Messahel, Esra Akyüz Özkan, Zanda Pučuka, Sofia Reis, Alexis Rybak, Malin Ryd Rinder, Ozlem Teksam, Caner Turan, Valtýr Stefánsson Thors, Roberto Velasco, Silvia Bressan, Henriette A Moll, Rianne Oostenbrink, Luigi Titomanlio, and in association with the REPEM network (Research in European Pediatric Emergency Medicine) as part of the EPISODES study group

Subjects
Medicine
Abstract

BackgroundDuring the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses.Methods and findingsRoutine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged ConclusionsReductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell.Trial registrationISRCTN91495258 https://www.isrctn.com/ISRCTN91495258.

Published
2022
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2. Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study

Author

Antonio Chiaretti, Borja Gomez, Ian Maconochie, Silvia Bressan, Damian Roland, Luigi Titomanlio, Ana Sofia Simões, Liviana Da Dalt, Henriette A Moll, Vanessa Gorito, Michael Barrett, Lina Jankauskaite, Niccolo Parri, Rianne Oostenbrink, Dorine Borensztajn, Ruud Nijman, Michael Bennett, Mark Lyttle, Danilo Buonsenso, Romain Basmaci, Stuart Hartshorn, Roberto Velasco, Susanne Greber-Platzer, Shrouk Messahel, Sylvester Gomes, Clarissa Barber, Romain Guedj, Zanda Pucuka, Kate Honeyford, João Viana, Patricia Macao, Camille Aupiais, Samuel Rhedin, Jonas Thüminger, Sofia Reis, Katy Rose, Zsolt Bognar, Tisham De, Ruth Farrugia, Alexis Rybak, Asgeir Haraldsson, Caner Turan, Christoph Zurl, Corinne Vasilico, Daniel Weghuber, Daniela Kohlfuerst, Danielle Rose, Esra Akyüz Özkan, Fiona Leonard, Florian Hey, Florian Hoffman, Francisca Saraiva, Gábor Simon, Inês Mascarenhas, John Jensen, Julia Lischka, Katarina Vincek, Laszlo Fodor, Lia Mano, Malin Ryd Rinder, Matthias Schaffert, Merve Havan, Mojca Kolnik, Naomi Lin, Nuno Serrade Almeida, Orkun Aydın, Ozlem Teksam, Paddy Fitzpatrick, Petra Salamon, Rohan Mongru, Rosa Morello, Sandra Soares Cardoso, Sofia Rapti, Sonia Andrade Santos, Susana Castanhinha, Thibault de Groc, Urdur Jonsdottir, Valtýr Stefánsson Thors, Vanda Anacleto, and Vytenis Masillonis

Subjects
Pediatrics, RJ1-570
Abstract

Objective Understanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave.Design This cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January–May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres.Results Overall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units (7%) increased their capacity. In 12 (31%) PEDs, they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs.There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.086).Conclusion Overall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.

Published
2021
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3. Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system

Author

Lea, Lenglart, Naim, Ouldali, Kate, Honeyford, Zsolt, Bognar, Silvia, Bressan, Danilo, Buonsenso, Liviana, Da Dalt, Tisham, De, Ruth, Farrugia, Ian K, Maconochie, Henriette A, Moll, Rianne, Oostenbrink, Niccolo, Parri, Damian, Roland, Katy, Rose, Esra, Akyüz Özkan, François, Angoulvant, Camille, Aupiais, Clarissa, Barber, Michael, Barrett, Romain, Basmaci, Susana, Castanhinha, Antonio, Chiaretti, Sheena, Durnin, Patrick, Fitzpatrick, Laszlo, Fodor, Borja, Gomez, Susanne, Greber-Platzer, Romain, Guedj, Florian, Hey, Lina, Jankauskaite, Daniela, Kohlfuerst, Ines, Mascarenhas, Anna Maria, Musolino, Zanda, Pučuka, Sofia, Reis, Alexis, Rybak, Petra, Salamon, Matthias, Schaffert, Keren, Shahar-Nissan, Maria Chiara, Supino, Ozlem, Teksam, Caner, Turan, Roberto, Velasco, Ruud G, Nijman, Luigi, Titomanlio, Vanda, Anacleto, Orkun, Aydin, Elena, Bellelli, Ron, Berant, Thibault, De Groc, Sara, Geitoeira, Florian, Hoffmann, Franziska, Leeb, Fiona, Leonard, Mark, Lyttle, Lia, Mano, Vytenis, Masillonis, Rosa, Morello, Francisa, Saraiva, Gabor, Simon, Ines Silva, Costa, Joao Sous, Marques, Jonas, Thüminger, Corinne, Vasilico, Anna Chiara, Vittucci, Christoph, Zurl, Pediatrics, Business Economics, Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Sainte Justine [Montréal], Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), The institute of cancer research [London], Pál Heim Children's Hospital = Heim Pál Gyermekkórház [Budapest], Azienda Ospedale Università di Padova = Hospital-University of Padua (AOUP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Imperial College London, Mater Dei Hospital [Malta], St Mary's Hospital [London], Hammersmith Hospital NHS Imperial College Healthcare, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Azienda Ospedaliero Universitaria A. Meyer [Firenze, Italy], University of Leicester, University Hospitals Leicester, Ondokuz Mayis University (OMU), Université Paris Cité (UPCité), AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Jean Verdier [AP-HP], North Bristol NHS Trust [Bristol, UK], Children's Health Ireland [Crumlin, Dublin, Ireland] (CHI), University College Dublin [Dublin] (UCD), Hôpital Louis Mourier - AP-HP [Colombes], Centro Hospitalar de Lisboa Central E.P.E, CHI at Tallaght Children's Outpatient and Emergency Care Unit [Tallaght, Ireland] (COECU), CHI at Temple Street [Temple Street, Ireland] (TS), Fejér County Szent György University Teaching Hospital [Szekesfehervar, Hungary] (FCSGUTH), Hospital Universitario Cruces = Cruces University Hospital, Medizinische Universität Wien = Medical University of Vienna, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Dr von Hauner Children's Hospital [Munich, Germany], Ludwig-Maximilians-Universität München (LMU), Ludwig-Maximilians University [Munich] (LMU), Hospital of Lithuanian University of Health Sciences Kauno Klinikos [Kaunas, Lithuania], Medical University of Graz, Hospital Prof Doutor Fernando Fonseca [Amadora, Portugal], Bambino Gesù Children’s Hospital [Rome, Italy], Children's Clinical University Hospital [Riga, Latvia] (CCUH), Centro Hospitalar Tondela-Viseu [Viseu, Portugal] (CHTV), Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), Schneider Children’s Medical Center [Petah Tikva, Israel] (SCMC), Hacettepe University = Hacettepe Üniversitesi, Mersin University, Rio Hortega University Hospital (Hospital Universitario Río Hortega) [Valladolid, Spain] (RHUH), Maladies neurodéveloppementales et neurovasculaires (NeuroDiderot (UMR_S_1141 / U1141)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), EPISODES Study Group., and Angoulvant, François

Subjects
[SDV] Life Sciences [q-bio], Pulmonary and Respiratory Medicine, SDG 3 - Good Health and Well-being, [SDV]Life Sciences [q-bio]
Abstract

BackgroundBronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries.MethodsWe conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling.ResultsIn total, 42 916 children were included. We observed an overall cumulative 78% (95% CI −100– −54%; pConclusionsSeveral NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.

Published
2022
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