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Full report: Impact of Covid-19 on emergency department attendances for young people
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Authors: Folasade Solanke, Stephanie Easton, Anna Selby, David James, Graham Roberts
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Published by: Archives of Diseases in Childhood, September 2022
SUMMARY
Researchers analysed an anonymised database of 166,459 patients aged 0 to 24 who presented to University Hospital Southampton NHS Foundation Trust emergency department (ED) over a five-year period from 1 April 2016.
The researchers used the data to estimate the numbers of children and young people who would have attended the ED if there had been no pandemic and compared this with the actual figures. They worked out there were 38.1 per cent fewer visits to the ED during the first year of the pandemic from March 2020 among this age group.
The most dramatic reductions in emergency hospital visits were seen in respiratory infections (a 59 per cent reduction), asthma/wheezing (55.9 per cent) and gastrointestinal infections (64.1 per cent). The authors suggest this could be because social distancing reduced infection rates while a drop in pollution levels contributed to a reduction in asthma-related conditions. There were no changes for allergic reactions, burns and scalds, and conditions requiring surgery such as appendicitis.
The data suggests the number of children and young people coming to the ED with mental health conditions fell by 30.3 per cent. However, while the number of 0- to 24-year-olds presenting with mental health emergencies declined overall, the number of 11- to 17-year-olds actually increased by 26.6 per cent.
There was a large fall in the number of boys and young men presenting with mental health problems – a reduction of 31.5 per cent. However, the number of girls and young women with mental health problems fell by just 1.3 per cent overall and rose by 14 per cent among those aged 11 to 17. The researchers suggest the number of girls aged five to 10 years presenting at the ED with mental health issues during the pandemic year was 19 per cent higher than it would have been without a pandemic, but the numbers involved are very small (see graphic).
Almost half of girls and young women presenting with mental health issues were aged 11 to 17 with 48 per cent aged 18 to 24. On the other hand, males presenting with mental health issues were more likely to be 18 to 24 (67 per cent) with only 26 per cent aged 11 to 17.
During the first pandemic year the number of children and young people admitted to hospital after coming to the ED fell by 23.4 per cent. There were dramatic reductions in infection-driven admissions – respiratory infections were down by 60.7 per cent and admissions related to asthma or wheeze fell by 42.6 per cent. Mental health admissions fell by 28.5 per cent overall but rose by four per cent for girls and young women aged 11 to 17.
Although the data showed some differences between age groups and sexes in relation to presentation and admission, there was no evidence ethnicity or socio-economic background had an impact on children and young people’s likelihood of presenting at the ED or being admitted to hospital during the pandemic.
The largest reductions in the number of children and young people presenting at the ED were associated with children being home-schooled rather than with national lockdowns, with a large increase in presentations coinciding with the return to in-person schooling in September 2020.
IMPLICATIONS FOR PRACTICE
The overall reduction in children and young people presenting at the ED in the first year of the pandemic highlights the need for clear government messaging that critically unwell young people should still seek care even in a national emergency.
The authors suggest the concerning rise in mental health presentations among 11- to 17-year-old girls could be driven by fewer face-to-face interactions with friends and by girls spending more time on smartphones and using social media. Greater digital media use has been associated with lower wellbeing. They say consideration needs to be given as to how to support this group.
FURTHER READING
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Loneliness, Social Relationships and Mental Health in Adolescents During the Covid-19 Pandemic, Kate Cooper and others, Journal of Affective Disorders, June 2021
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Where Have All the Children Gone? Decreases in Paediatric Emergency Department Attendances at the Start of the Covid-19 Pandemic of 2020, Rachel Isba and others, Archives of Disease in Childhood, June 2020
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Children’s Emergency Presentations During the Covid-19 Pandemic, Damian Roland and others, The Lancet Child and Adolescent Health, June 2020
