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  • Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study

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Original research
Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study
  1. Thomas C Williams1,
  2. Clare MacRae2,
  3. Olivia V Swann3,4,
  4. Haris Haseeb1,
  5. Steve Cunningham1,5,
  6. Philip Davies6,
  7. Neil Gibson6,
  8. Christopher Lamb7,
  9. Richard Levin7,
  10. Catherine M McDougall1,8,
  11. Jillian McFadzean8,
  12. Ian Piper8,
  13. Alastair Turner7,
  14. Stephen W Turner9,
  15. Margrethe Van Dijke8,
  16. Donald S Urquhart1,3,
  17. Bruce Guthrie2,
  18. Ross J Langley6
  1. 1 Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
  2. 2 Usher Institute, The University of Edinburgh, Edinburgh, UK
  3. 3 Department of Child Life and Health, The University of Edinburgh, Edinburgh, UK
  4. 4 Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
  5. 5 Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
  6. 6 Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
  7. 7 Critical Care, Royal Hospital for Children, Glasgow, UK
  8. 8 Critical Care, Royal Hospital for Sick Children, Edinburgh, UK
  9. 9 Department of Child Health, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Ross J Langley, Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow G51 4TF, UK; ross.langley{at}ggc.scot.nhs.uk

Abstract

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.

  • mortality
  • epidemiology
  • COVID-19

Data availability statement

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).

This article is made freely available for 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.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2020-321008

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    Data availability statement

    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).

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    Footnotes

    • Twitter @williams_t_c

    • BG and RJL contributed equally.

    • Contributors RJL and TCW conceived the study. CMR, OS, SC, PD, NG, SWT, DSU and BG made substantial contributions to the design of the work. CL, RL, CMM, CMR, JMF, IP, AT and MVD contributed towards acquisition of data for the work. TCW, CMR and HH performed the analysis and interpretation of the data. RJL, TCW, CMR and OS drafted the manuscript. SC, PD, NG, SWT, DSU, BG, CL, RJL, CMR, JMF, IP, AT and MVD revised it critically for important intellectual content.

    • Funding TCW is the recipient of a Wellcome Trust Award (204802/Z/16/Z).

    • 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.