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Paediatric ED utilisation in the early phase of the COVID-19 pandemic
  1. Lois Lee1,
  2. Rebekah Mannix1,
  3. Romain Guedj2,
  4. Shu-Ling Chong3,
  5. Sidney Sunwoo4,
  6. Tony Woodward5,
  7. Eric Fleegler1
  1. 1 Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2 Division of Pediatric Emergency Medicine, Hôpital Armand-Trousseau, Paris, Île-de-France, France
  3. 3 Department of Children's Emergency, KK Women's and Chlidren's Hospital, Singapore
  4. 4 Division of Emergency Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  5. 5 Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
  1. Correspondence to Dr Lois Lee, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA; lois.lee{at}


Background Past epidemics, including influenza, have resulted in increased paediatric patient volume in EDs. During the early weeks of the COVID-19 pandemic, it was unclear how ED volume would be impacted in paediatric hospitals. The objective of this study was to examine differences in the international experience of paediatric ED utilisation and disposition at five different children’s hospitals.

Methods We obtained data on ED volume, acuity level and disposition (hospitalisation and intensive care unit (ICU) admission) for the time period 1 December1–10 August for the years 2017–2020 from hospitals in five cities (Boston, Massachusetts, USA; Singapore; Melbourne, Australia; Seattle, Washington, USA; and Paris, France). Per cent change was analysed using paired t-tests or Wilcoxon signed rank test.

Results Overall ED volume dramatically decreased in all five hospitals during the early months of COVID-19 compared with prior years. There was a more varied response of decreases in ED volume by acuity level, hospitalisation and ICU admission among the five hospitals. The one exception was a 2% increase in ICU admissions in Paris. As of August 2020, all hospitals have demonstrated increases in ED volume; however, they are still below baseline.

Conclusion Paediatric EDs in these five cities demonstrated differential decreases of ED volume by acuity and disposition during the early months of the COVID-19 pandemic.

  • paediatrics
  • paediatric emergency medicine
  • emergency care systems

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  • Handling editor Edward Carlton

  • Twitter @LoisLeeMD

  • Contributors EF, RM and LL conceived the study. EF, RG, S-LC, SS and TW provided data. EF and RM conducted the statistical analysis. LL conducted the literature search and drafted the initial manuscript. All authors contributed to the data interpretation and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests LL has received payment from the American College of Emergency Physicians as an editorial board member for Annals of Emergency Medicine.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was deemed exempt from Institutional Review Board approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified participant data are available from the corresponding author under reasonable request. Reuse is permitted only with appropriate citation of the data source.