Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Data Source and Setting
2.2. Period Definitions
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. Total Visits
3.2. Critical Illness Visits
3.3. Hospitalization Rate
3.4. Cause-Specific Visits
3.4.1. Transmissible Infectious Diseases
3.4.2. Non-Transmissible Infectious Diseases
3.4.3. Trauma
3.4.4. Mental Health
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. ICD-10 Codes Used to Classify Visits in Etiological Categories
Appendix B
Outcome | Model | Distribution | Offset | Seasonality Adjustment | Correlation Structure |
---|---|---|---|---|---|
Total visits | GAMM | Negative binomial | - | Spline of week (k = 52), time | AR(1) with random intercept for month |
Critical illness | GLM | Poisson | - | Dummy variable for month | - |
Hospitaliza-tions | GAMM | Negative binomial | Total visits | Spline of week (k = 52), time | AR(1) with random intercept for month |
Transmissible infectious diseases | GAMM | Negative binomial | - | Spline of week (k = 52), time | AR(1) with random intercept for month |
Non-transmissible infectious diseases | GAM | Negative binomial | - | Spline of week (k = 52), time | - |
Trauma | GAM | Negative binomial | - | Spline of week (k = 52), time | - |
Mental health | GLM | Zero-inflated Poisson (ZIP) | - | Dummy variable for month | - |
Appendix C
Response Variable | Contrast | EMMs Ratio | S.E. | d.f | T Ratio | p Value |
---|---|---|---|---|---|---|
Total visits | (Pre-pandemic)—FL | 3.210 | 0.2652 | 246 | 14.116 | <0.001 |
(Pre-pandemic)—PL | 2.799 | 0.3950 | 246 | 7.292 | <0.001 | |
(Pre-pandemic)—SL | 2.508 | 0.4320 | 246 | 5.337 | <0.001 | |
FL—PL | 0.872 | 0.0813 | 246 | −1.470 | 0.457 | |
FL—SL | 0.781 | 0.1064 | 246 | −1.813 | 0.269 | |
PL—SL | 0.896 | 0.0829 | 246 | −1.187 | 0.635 | |
Critical illness | (Pre-pandemic)—FL | 2.67 | 1.278 | Inf | 2.050 | 0.169 |
(Pre-pandemic)—PL | 3.63 | 3.264 | Inf | 1.434 | 0.477 | |
(Pre-pandemic)—SL | 11.13 | 12.180 | Inf | 2.202 | 0.122 | |
FL—PL | 1.36 | 0.788 | Inf | 0.531 | 0.951 | |
FL—SL | 4.17 | 3.555 | Inf | 1.676 | 0.336 | |
PL—SL | 3.07 | 1.779 | Inf | 1.931 | 0.215 | |
Hospitalizations | (Pre-pandemic)—FL | 0.541 | 0.0475 | 249 | −6.999 | <0.001 |
(Pre-pandemic)—PL | 0.603 | 0.0947 | 249 | −3.218 | 0.007 | |
(Pre-pandemic)—SL | 0.638 | 0.1206 | 249 | −2.375 | 0.084 | |
FL—PL | 1.115 | 0.1145 | 249 | 1.056 | 0.716 | |
FL—SL | 1.179 | 0.1735 | 249 | 1.119 | 0.678 | |
PL—SL | 1.058 | 0.1016 | 249 | 0.585 | 0.936 | |
Transmissible infectious diseases | (Pre-pandemic)—FL | 5.42 | 0.709 | 245 | 12.921 | <0.001 |
(Pre-pandemic)—PL | 4.93 | 1.093 | 7.194 | <0.001 | ||
(Pre-pandemic)—SL | 5.95 | 1.612 | 245 | 6.583 | <0.001 | |
FL—PL | 0.91 | 0.133 | 245 | −0.647 | 0.916 | |
FL—SL | 1.10 | 0.235 | 245 | 0.435 | 0.972 | |
PL—SL | 1.21 | 0.176 | 245 | 1.286 | 0.572 | |
Non-transmissible infectious diseases | (Pre-pandemic)—FL | 9.653 | 3.910 | 246 | 5.597 | <0.001 |
(Pre-pandemic)—PL | 4.105 | 3.051 | 246 | 1.900 | 0.230 | |
(Pre-pandemic)—SL | 6.802 | 5.598 | 246 | 2.329 | 0.094 | |
FL—PL | 0.425 | 0.196 | 246 | −1.860 | 0.248 | |
FL—SL | 0.705 | 0.409 | 246 | −0.603 | 0.931 | |
PL—SL | 1.657 | 0.537 | 246 | 1.556 | 0.405 | |
Trauma | (Pre-pandemic)—FL | 1.656 | 0.1969 | 246 | 4.240 | <0.001 |
(Pre-pandemic)—PL | 1.565 | 0.3282 | 246 | 2.135 | 0.144 | |
(Pre-pandemic)—SL | 1.006 | 0.2470 | 246 | 0.025 | 1.000 | |
FL—PL | 0.945 | 0.1211 | 246 | −0.440 | 0.971 | |
FL—SL | 0.608 | 0.1100 | 246 | −2.751 | 0.032 | |
PL—SL | 0.643 | 0.0742 | 246 | −3.825 | <0.001 | |
Mental health | (Pre-pandemic)—FL | 4.321 | 3.033 | 243 | 2.085 | 0.161 |
(Pre-pandemic)—PL | 4.411 | 4.354 | 1.504 | 0.436 | ||
(Pre-pandemic)—SL | 2.454 | 2.736 | 0.805 | 0.852 | ||
FL—PL | 1.021 | 0.487 | 0.043 | 1.000 | ||
FL—SL | 0.568 | 0.401 | −0.801 | 0.853 | ||
PL—SL | 0.556 | 0.263 | −1.242 | 0.600 |
Age Stratum | Variables | Total Visits | Critical Illness | Hospitalization Rates | ||||||
---|---|---|---|---|---|---|---|---|---|---|
IRR | 95% CI | p | IRR | 95% CI | p | IRR | 95% CI | p | ||
0–6 years | Level | |||||||||
FL | 0.29 | 0.25, 0.35 | <0.001 | 0.37 | 0.10, 1.02 | 0.086 | 1.84 | 1.52, 2.21 | <0.001 | |
PL | 0.33 | 0.25, 0.46 | <0.001 | 0.31 | 0.03, 2.63 | 0.300 | 1.68 | 1.19, 2.36 | 0.003 | |
SL | 0.36 | 0.25, 0.53 | <0.001 | 0.14 | 0.01, 1.76 | 0.130 | 1.52 | 1.01, 2.29 | 0.045 | |
Trend | ||||||||||
FL | 1.07 | 1.03, 1.11 | <0.001 | 1.07 | 0.83, 1.40 | 0.600 | 0.96 | 0.92, 1.00 | 0.069 | |
PL | 0.93 | 0.89, 0.97 | <0.001 | 0.97 | 0.74, 1.26 | 0.800 | 1.05 | 1.01, 1.10 | 0.018 | |
SL | 0.93 | 0.89, 0.98 | 0.003 | 0.84 | 0.61, 1.16 | 0.300 | 0.99 | 0.95, 1.03 | 0.600 | |
7–12 years | Level | |||||||||
FL | 0.26 | 0.22, 0.32 | <0.001 | 0.56 | 0.03, 3.21 | 0.600 | 2.24 | 1.69, 2.98 | <0.001 | |
PL | 0.32 | 0.22, 0.45 | <0.001 | 1.55 | 0.01, 910 | 0.900 | 2.14 | 1.27, 3.63 | 0.005 | |
SL | 0.36 | 0.23, 0.55 | <0.001 | 0.48 | 0.00, 378 | 0.800 | 2.22 | 1.18, 4.18 | 0.014 | |
Trend | ||||||||||
FL | 1.11 | 1.06, 1.15 | <0.001 | 0.84 | 0.38, 1.53 | 0.600 | 0.91 | 0.86, 0.97 | 0.005 | |
PL | 0.89 | 0.86, 0.94 | <0.001 | 1.25 | 0.68, 2.75 | 0.500 | 1.11 | 1.04, 1.18 | 0.001 | |
SL | 0.95 | 0.90, 1.00 | 0.039 | 1.08 | 0.72, 1.68 | 0.700 | 1.01 | 0.95, 1.09 | 0.700 | |
>12 years | Level | |||||||||
FL | 0.22 | 0.17, 0.28 | <0.001 | 0.26 | 0.02, 4.22 | 0.300 | 1.8 | 1.36, 2.39 | <0.001 | |
PL | 0.26 | 0.16, 0.42 | <0.001 | 0.05 | 0.00, 4.98 | 0.200 | 1.32 | 0.76, 2.31 | 0.300 | |
SL | 0.34 | 0.19, 0.60 | <0.001 | 0 | 0.00, Inf | 1.000 | 1.29 | 0.66, 2.52 | 0.500 | |
Trend | ||||||||||
FL | 1.15 | 1.09, 1.22 | <0.001 | 1.38 | 0.80, 2.38 | 0.200 | 0.97 | 0.91, 1.04 | 0.400 | |
PL | 0.86 | 0.81, 0.91 | <0.001 | 0.75 | 0.43, 1.32 | 0.300 | 1.04 | 0.97, 1.11 | 0.300 | |
SL | 0.96 | 0.90, 1.02 | 0.200 | 51,626 | 0.00, Inf | 1.000 | 1.04 | 0.97, 1.11 | 0.300 |
Appendix D
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Variable | Pandemic Period, N = 13,180 | Pre-Pandemic Period, N = 112,701 | p-Value |
---|---|---|---|
Total visits | 337 (279–389) 1 | 668 (620–722) 1 | <0.001 2 |
Triage code | <0.001 3 | ||
Non urgent (white code) | 101 (0.8%) | 881 (0.8%) | |
Low acuity (green code) | 9201 (70%) | 78,231 (73%) | |
High acuity (yellow code) | 3765 (29%) | 27,020 (25%) | |
Dead on arrival (black code) | 0 (0%) | 23 (<0.1%) | |
Critical illness visits (red code) | 113 (0.9%) | 649 (0.6%) | <0.001 4 |
Hospitalizations | 3769 (29%) | 22,502 (20%) | <0.001 4 |
Transmissible infectious diseases | 2759 (21%) | 39,008 (35%) | <0.001 4 |
Non-transmissible infectious diseases | 330 (2.5%) | 4425 (3.9%) | <0.001 4 |
Trauma | 3112 (24%) | 15,961 (14%) | <0.001 4 |
Mental health | 115 (0.9%) | 610 (0.5%) | <0.001 4 |
ICU admissions | 33 (0.3%) | 168 (0.1%) | 0.006 4 |
Age (yrs.) | 5.0 (2.0–10.0) 1 | 5.0 (2.0–9.0) 1 | <0.001 1 |
Age (strata) | <0.001 4 | ||
0–6 | 7583 (58%) | 67,573 (60%) | |
7–12 | 4150 (31%) | 34,441 (31%) | |
>12 | 1447 (11%) | 10,687 (9.5%) | |
Comorbidity | 122 (0.9%) | 1528 (1.4%) | <0.001 3 |
Characteristic | Pandemic Period, N = 113 | Pre-Pandemic Period, N = 647 | p-Value |
---|---|---|---|
Age | 4.0 (2.0–8.0) 1 | 4.0 (2.0–8.0) 1 | 0.600 2 |
Comorbidity | 1 (0.9%) | 18 (2.8%) | 0.300 3 |
Visit outcome | |||
Proposed admission | 93 (82%) | 512 (79%) | 0.500 3 |
Refused admission | 5 (4.4%) | 23 (3.6%) | 0.600 3 |
Refused brief intensive observation | 6 (5.3%) | 17 (2.6%) | 0.140 3 |
Deceased | 1 (0.9%) | 2 (0.3%) | 0.400 3 |
ICU admission | 13 (12%) | 75 (12%) | 0.999 3 |
Etiology | |||
Transmissible infectious diseases | 23 (20%) | 188 (29%) | 0.068 3 |
Non-transmissible infectious diseases | 0 (0%) | 2 (0.3%) | 0.999 3 |
Trauma | 11 (9.7%) | 76 (12%) | 0.600 3 |
Mental health | 0 (0%) | 3 (0.5%) | 0.999 3 |
Neurologic diseases | 38 (34%) | 163 (25%) | 0.065 3 |
Variable | IRR | 95% CI | p-Value |
---|---|---|---|
Level | |||
FL | 0.31 | 0.27, 0.37 | <0.001 |
PL | 0.36 | 0.27, 0.48 | <0.001 |
SL | 0.40 | 0.29, 0.57 | <0.001 |
Trend | |||
FL | 1.07 | 1.04, 1.11 | <0.001 |
PL | 0.92 | 0.89, 0.96 | <0.001 |
SL | 0.94 | 0.90, 0.98 | 0.006 |
s (week) | <0.001 | ||
s (time) | <0.001 |
Variable | IRR | 95% CI | p-Value |
---|---|---|---|
Level | |||
FL | 0.37 | 0.13, 0.88 | 0.040 |
PL | 0.28 | 0.05, 1.62 | 0.200 |
SL | 0.09 | 0.01, 0.74 | 0.027 |
Trend | |||
FL | 1.08 | 0.87, 1.34 | 0.500 |
PL | 0.96 | 0.77, 1.19 | 0.700 |
SL | 0.95 | 0.75, 1.22 | 0.700 |
Month | |||
January | — | — | — |
February | 1.26 | 0.98, 1.62 | 0.068 |
March | 0.89 | 0.68, 1.17 | 0.400 |
April | 0.78 | 0.59, 1.04 | 0.094 |
May | 0.76 | 0.56, 1.01 | 0.062 |
June | 0.68 | 0.50, 0.92 | 0.012 |
July | 0.67 | 0.50, 0.89 | 0.006 |
August | 0.78 | 0.59, 1.04 | 0.093 |
September | 0.75 | 0.56, 0.99 | 0.042 |
October | 0.61 | 0.45, 0.82 | 0.001 |
November | 0.65 | 0.47, 0.88 | 0.006 |
December | 0.90 | 0.68, 1.18 | 0.400 |
Transmissible Infectious Disease | Non-Transmissible Infectious Disease | Trauma | Mental Health | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Level | IRR | 95% CI | p | IRR | 95% CI | p | IRR | 95% CI | p | IRR | 95% CI | p |
FL | 0.18 | 0.14, 0.24 | <0.001 | 0.1 | 0.04, 0.25 | <0.001 | 0.6 | 0.48, 0.76 | <0.001 | 0.23 | 0.06, 0.92 | 0.037 |
PL | 0.2 | 0.13, 0.31 | <0.001 | 0.24 | 0.06, 1.04 | 0.056 | 0.64 | 0.42, 0.96 | 0.033 | 0.23 | 0.03, 1.57 | 0.130 |
SL | 0.17 | 0.10, 0.29 | <0.001 | 0.15 | 0.03, 0.79 | 0.025 | 0.99 | 0.61, 1.60 | >0.9 | 0.41 | 0.05, 3.63 | 0.400 |
Trend | ||||||||||||
FL | 1.05 | 0.99, 1.11 | 0.081 | 1.07 | 0.90, 1.28 | 0.400 | 1.08 | 1.03, 1.14 | 0.002 | 1.17 | 0.92, 1.48 | 0.200 |
PL | 0.97 | 0.91, 1.02 | 0.200 | 0.94 | 0.78, 1.12 | 0.500 | 0.91 | 0.86, 0.96 | <0.001 | 0.85 | 0.67, 1.08 | 0.200 |
SL | 0.91 | 0.85, 0.97 | 0.006 | 0.97 | 0.84, 1.11 | 0.600 | 0.96 | 0.92, 1.01 | 0.150 | 0.95 | 0.80, 1.14 | 0.600 |
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Alongi, A.; D’Aiuto, F.; Montomoli, C.; Borrelli, P. Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis. Healthcare 2023, 11, 1638. https://doi.org/10.3390/healthcare11111638
Alongi A, D’Aiuto F, Montomoli C, Borrelli P. Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis. Healthcare. 2023; 11(11):1638. https://doi.org/10.3390/healthcare11111638
Chicago/Turabian StyleAlongi, Alessandra, Francesca D’Aiuto, Cristina Montomoli, and Paola Borrelli. 2023. "Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis" Healthcare 11, no. 11: 1638. https://doi.org/10.3390/healthcare11111638