Influence of epidemics and pandemics on paediatric ED use: a systematic review

Objective To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. Setting Systematic review. Design Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). Patients Children under 18 years. Interventions National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. Main outcome measures Changes in paediatric emergency care utilisation. Results 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. Conclusions The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. Through a systematic review, the authors assessed the impact of epidemics and pandemics on the utilisation of paediatric emergency care services, and found that epidemics have profound but extremely variable effects.