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1731 Epidemiology, severity and outcomes of children presenting to emergency departments across Europe during the SARS-COV-2 pandemic: an observational cohort study
  1. Ruud Nijman1,
  2. Kate Honeyford2,
  3. Silvia Bressan3,
  4. Luigi Titomanlio4,
  5. Study group EPISODES study5
  1. 1Imperial College of Science, Technology and Medicine, Section of Paediatric Infectious Diseases, London, UK
  2. 2Imperial College London, Faculty of Medicine, School of Public Health, London, UK
  3. 3University Hospital of Padova, Division of Pediatric Emergency Medicine, Padova, Italy
  4. 4Robert Debré Paediatric Hospital, Paediatric Emergency Department, Paris, France
  5. 5Imperial College London, Section of Paediatrics, London, UK


Background An unprecedented reduction in paediatric emergency department (PED) attendances has been reported following the introduction of social distancing measures during the first wave of the SARS-CoV-2 pandemic in the UK. Emerging evidence also suggests changes in the type of acute presentations to urgency and emergency care.

Objectives We aimed to describe the patterns of children presenting to PEDs across Europe during the first wave of the SAS-CoV-2 pandemic, and compare these with historical data, to understand the timeliness of their presentations in relation to the disease severity, and to monitor for emerging disease entities.

Methods The ‘Epidemiology, severity and outcomes of children presenting to emergency departments across Europe during the SARS-CoV-2 pandemic’ (EPISODES) - study collected data from 39 PEDs in 18 countries including 6 UK sites. Routine clinical data were extracted from electronic health records for all children aged <16 years from January 2018 – May 2020, and these were uploaded using a standardised data entry form on the validated online REDCap system. Standardised 28-day rates were calculated for PED attendance, hospital admission, and selected diagnoses; interrupted times series were performed. Ethics approval was obtained at all study sites

Results PED attendances varied between 420 and 6,370 between sites for January 2020. Across sites, a reduction in PED attendances (March 2020 vs March 2021) ranged from 29.0% in children aged 5–12 years to 44.8% in children <14 days; a larger reduction was seen at the 6 UK sites. In a preliminary sample across sites, no increase was seen for appendicitis (standardised 28-day number of patients of 181 in April 2018 vs 219 in April 2019 vs 182 in April 2020) or diabetic ketoacidosis (27 vs 29 vs 28); a reduction was observed for otitis media (1628 vs 1538 vs 214), tonsillitis (3672 vs 3506 vs 776), and mental health issues (329 vs 300 vs 176). Reductions in hospital admissions were seen for any type of admission, including admissions >72 hours and to intensive care.

Conclusions This multinational study confirms a dramatic reduction in PED attendances of all levels of severity observed during the first wave of COVID-19 across Europe. The reduction was consistent in all participating sites, despite the heterogeneity in social distancing measures introduced. We did not find an increase in appendicitis or diabetic ketoacidosis, and a decrease for mental health issues.

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