963 Paediatric emergency department usage during the April 2020 COVID19 lockdown

Background On March 23, 2020, the UK prime minister declared a public lockdown to decrease the spread of the SARS CoV 2 virus. This led to a change in health care organization and utilization, with GP surgeries and outpatient clinics changing to predominantly telephone or online consultations, and altered presentations to emergency departments. Objectives We aimed to understand the impact of the lockdown on the presentation of medical conditions in children presenting to our paediatric emergency department (PED). Methods We retrospectively analysed the Electronic Patient Records (EPR) for all children (aged 0 to 16 years) presenting to our PED in the first month of lockdown (April 2020) and looked at the number of discharge diagnoses within clinical groups (surgical, medical, trauma, mental health, other) and specific subgroups. We then compared the attendance in each of these groups with the average attendance in the previous 4 years (2016-2019), looking at the same month (April) to control for seasonal fluctuation in medical and trauma PED presentations. Results 624 patients were seen in our PED in April 2020, compared to between 1620-1710 patients in previous years. All clinical groups showed reduced numbers, with medical, surgical, trauma, mental health and 'other' presentations reduced by respectively 67%, 46%, 66%, 20% and 43% compared with the average in preceding years. There was a significant decrease in children presenting with respiratory tract infections (63%), febrile seizures (41%), afebrile seizures (27%), urinary tract infections (67%), fractures (65%), and head injuries (44%). There was a decrease in head injuries (56%) and fractures in children less than 18 months (44%), the group most at risk for non-accidental injury. The number of children presenting with appendicitis, testicular torsion, overdoses, and children aged less than 3 months with presumed sepsis, were within the expected range. In April 2020 there were three cases of severe diabetic ketoacidosis (compared to only two in 2016 and none in 2017, 2018 and 2019). Conclusions The lockdown significantly decreased PED attendance, and our data highlights several potential reasons, including a reduced burden of respiratory disease, changes in parental health seeking behaviour and possible barriers to attendance. The reduction in attendance was mainly in medical and trauma presentations. This could be explained by a decreased burden of infectious respiratory disease, and a reduction in injuries due to less road traffic and sport. Interestingly, non communicable medical conditions (urinary tract infection/pyelonephritis) and afebrile seizures also demonstrated a decreased rate, pointing to potential changes in parental health seeking behaviour. The increase in severe DKA presentations could indicate barriers (logistical or psychological) to attending primary/secondary health care. Overall, though the surgical attendances were decreased, presentations for surgical emergencies remained the same. Intriguingly, there was no increased attendance for mental health reasons. We found no evidence of increased domestic violence involving children in our population. Our data highlights that the lockdown was effective in decreasing the burden of both respiratory infections, and trauma patients presenting to ED. Our study will support workforce planning and resource allocation in paediatric ED, especially during staff redeployment.