TY - JOUR T1 - Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study JF - Archives of Disease in Childhood JO - Arch Dis Child SP - 911 LP - 917 DO - 10.1136/archdischild-2020-321008 VL - 106 IS - 9 AU - Thomas C Williams AU - Clare MacRae AU - Olivia V Swann AU - Haris Haseeb AU - Steve Cunningham AU - Philip Davies AU - Neil Gibson AU - Christopher Lamb AU - Richard Levin AU - Catherine M McDougall AU - Jillian McFadzean AU - Ian Piper AU - Alastair Turner AU - Stephen W Turner AU - Margrethe Van Dijke AU - Donald S Urquhart AU - Bruce Guthrie AU - Ross J Langley Y1 - 2021/09/01 UR - http://adc.bmj.com/content/106/9/911.abstract N2 - Objectives To determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on 23 March 2020.Design National retrospective cohort study.Setting Emergency childhood primary and secondary care providers across Scotland; two national paediatric intensive care units (PICUs); statutory death records.Participants 273 455 unscheduled primary care attendances; 462 437 emergency department attendances; 54 076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years.Main outcome measures Rates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all data sets, rates during the lockdown period were compared with mean or aggregated rates for the equivalent dates in 2016–2019.Results 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 as a proportion of cases for the entire population, with an OR of 0.52 for likelihood of admission during lockdown (95% CI 0.37 to 0.73), compared with the equivalent period in previous years. 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 with 2016–2019.Conclusions National lockdown led to a reduction in paediatric emergency care utilisation, without associated evidence of severe harm.Data are available in a public, open access repository. The source code for all the analyses, alongside the anonymised data sets used in these, has been published on GitLab (https://git.ecdf.ed.ac.uk/twillia2/indirect_effects_covid-19_open_data). ER -