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Influence of epidemics and pandemics on paediatric ED use: a systematic review
  1. Damian Roland1,2,
  2. Adam Gardiner3,
  3. Darakhshan Razzaq4,
  4. Katy Rose5,6,
  5. Silvia Bressan7,
  6. Kate Honeyford8,
  7. Danilo Buonsenso9,10,
  8. Liviana Da Dalt7,
  9. Tisham De11,
  10. Ruth Farrugia12,
  11. Niccolo Parri13,
  12. Rianne oostenbrink14,
  13. Ian K Maconochie5,
  14. Zsolt Bognar15,
  15. Henriette A Moll14,
  16. Luigi Titomanlio16,
  17. Ruud Gerard Gerard Nijman5,17
  18. in association with the REPEM network (Research in European Paediatric Emergency Medicine) as part of the EPISODES Study
  1. 1 SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
  2. 2 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3 School of Medicine, University of Leicester, Leicester, UK
  4. 4 Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
  5. 5 Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
  6. 6 Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
  7. 7 Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
  8. 8 Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
  9. 9 Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
  10. 10 Universita Cattolica del Sacro Cuore, Rome, Italy
  11. 11 Imperial College Medical School, Imperial College London, London, UK
  12. 12 Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
  13. 13 Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
  14. 14 Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
  15. 15 Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
  16. 16 Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
  17. 17 Section of Paediatric Infectious Diseases, Imperial College London, London, UK
  1. Correspondence to Professor Damian Roland, Health Sciences, University of Leicester, Leicester, UK; dr98{at}


Objective To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice.

Setting Systematic review.

Design Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO).

Patients Children under 18 years.

Interventions National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used.

Main outcome measures Changes in paediatric emergency care utilisation.

Results 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of −16.5% to −89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively.

Conclusions The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed.

Trial registration number CRD42021242808.

  • emergency care
  • child health services
  • communicable diseases
  • epidemiology
  • global health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @damian_roland, @rgnijman

  • Contributors Damian Roland (DR) and AG designed the study with all authors contributing to the development PROSPERO protocol. DR, AG & D Razzaq were responsible for initial abstract identification and data extraction. DR is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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