Misuse of the Pediatric Emergency Service and COVID-19 pandemic lessons in Peru

Authors

Keywords:

Emergency Service, pediatrics, misuse of health services, pandemic, COVID-19.

Abstract

Introduction: Covid-19 Pandemic could have impacted the perception and visits to the Pediatric Emergency Services. Objective: To describe the variation of non-urgent visits to the Pediatric Emergency Services before, during and after Covid 19 Pandemic, according to the priority category. Methods: A transversal retrospective study was carried out using the data base of Hospital de Emergencias Pediátricas in Lima, Perú, from April 2019 to 2023. Four stages were stablished: pre pandemic, pandemic-stage 1, pandemic-stage 2 y post pandemic. The principal variable was the level of priority: major emergency, emergency, major urgency, minor urgency and non-urgency. Results: One hundred forty-eight thousand two hundred ninety-seven assists were registered; 55.4% of them were male. The most common conditions were clinical abnormalities (28.7%), respiratory problems (24.2%), and infectious/parasitic problems (21.3%). Major emergencies represented 78%. There was an increase in minor emergencies from 5% in the pre-pandemic period to 27.7% in the post-pandemic period. The majority of these minor emergencies or non-emergencies (73.4%) took place during the week and during daylight hours. Conclusions: Strategies must be established to prevent overloading of the Emergency Service with health problems that can be treated in an outpatient consultation, and to standardize the definitions of non-urgent visits.

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References

1. O’Cathain A, Connell J, Long J, Coster J Clinically unnecessary use of emergency and urgent care: A realist review of patient’s decision making. Health Expect. 2020;23:19-40. DOI: https://doi.org/10.1111/hex.12995

2. Wise M. Inappropriate attendance in accidents and Emergency. Accident and Emergency Nursing. 1997 [acceso 01/04/2024];5(3):102-6. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0965230297900916?via%3Dihub

3. Isba R, Edge R, Jenner R, Broughton E, Francis N, Butler J. Where have all the children gone? Decreases in pediatric emergency department attendances at the start of the COVID-19 pandemic of 2020. Archs Dis Child. 2020 [acceso 01/04/2024];105(7). Disponible en: https://adc.bmj.com/content/105/7/704.1.long

4. Honeyford K, Coughian C, Nijman R, Expert P, Burcea G, Maconochie I, et al. Changes in emergency department activity and the first COVID-19 Lockdown: A cross-sectional study. West J Emergency Medicine. 2021 [acceso 24/03/2024];22(3):603-8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203011

5. Dann L, Firtzsimons K, Gorman K, Hourihabe J, Okafor I. Disappearing act: COVID-19 and pediatrics emergency department attendances. Arch Dis Child. 2020 [acceso 26/03/2024];105(8):810-11. Disponible en: https://adc.bmj.com/content/105/8/810.long

6. Cajachagua-Torres KN, Quezada-Pinedo HG, Huayanay-Espinoza CA, Obeso-Manrique JA, Peña Rodriguez VA, Vidal E, et al. COVID-19 and drives of excess death rate in Peru: A longitudinal ecological study. Heliyon. 2022 [acceso 01/04/2024];8(12). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9710104

7. Stramandinoli A, Alvarado-Zuñiga J, Alvarado GF, Esgúsquiza-Zuzunaga G, Carreazo NY. Comparative changes in emergency department patient attendance at the Pediatric Emergency Hospital during the first wave between 2019 and 2020. Rev Peru Med Exp Salud Publica. 2022 [acceso 25/03/2024];39(3):345-51. Disponible en: https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/11245

8. Bahadori M, Mousavi SM, Teymourzadeh E, Ravangard R. Emergency department visits for non-urgent conditions in Iran: a cross-sectional study. BMJ Open. 2019;9(10). DOI: https://doi.org/10.1136/bmjopen-2019-030927

9. O’Keeffe C, Mason S, Jacques R, Nicholl J. Characterizing non-urgent users of the Emergency Department (ED): A retrospective analysis of routine ED data. PLOS One. 2018 [acceso 01/04/2024];13(2). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825051

10. Jaboyedoff M, Starvaggi C, Suris JC, Kuehni CE, Gehri M, Keitel K, et al. Characteristics of low-acuity paediatric emergency department consultations in two tertiary hospitals in Switzerland: a retrospective observational study. BMJ Paediatr Open. 2021 [acceso 20/03/2024];5(1). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634019

11. Alele FO, Callander EJ, Emeto T, Mills J, Watt K. Socio-economic composition of low-acuity paediatric presentation at a regional hospital emergency department. J Paediatr Child Health. 2018 [acceso 18/03/2024];54(12):1341-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29863756

12. Melnick G, O’Leary JF, Zaniello BA, Abrishamian L. COVID-19 driven decline in emergency visits: Has it continued, is it permanent, and what does it mean for emergency physicians? Am J Emerg Med. 2022;61:64-7. DOI: https://doi.org/10.1016/j.ajem.2022.08.031

13. O’Carroll D. COVID-19 in emergency departments: Buckle up! United Kingdom. Medscape. 2021 [acceso 01/08/2023]. Disponible en: https://www.medscape.co.uk/viewarticle/covid-19-emergency-departments-buckle-2021a1001wg9

14. Plunkett-Reilly C. Health and Social Care Select Committee: Written evidence submitted by the Royal College of Pediatrics and Child Health. RCPCH. 2021 [acceso 01/08/2023]. Disponible en: https://www.rcpch.ac.uk/sites/default/files/2021-09/RCPCH%20%20clearing%20the%20backlog%20caused%20by%20the%20pandemic.pdf

15. Alele FO, Emeto TI, Callander EJ, Watt K. Non-urgent paediatric emergency department presentation: A systematic review. J Paediatr Child Health. 2019 [acceso 23/09/2023];55(3):271-7. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/jpc.14352

16. Simpson RM, Keeffe C, Jacques R, Stone T, Hassan A, Mason S. Non-urgent emergency department attendances in children: a retrospective observational analysis. Emerg Med K. 2022 [acceso 03/04/2024];39:17-22. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717488

17. Ruiz-Frutos C, Palomino-Baldeón JC, Ortega-Moreno M, Villavicencio-Guardia MDC, Dias A, Bernardes JM, et al. Effects of the COVID-19 Pandemic on Mental Health in Peru: Psychological Distress. Healthcare (Basel). 2021;9(6). DOI: https://doi.org/10.3390/healthcare9060691

18. Galdos-Bejar MN, Belanovic Ramirez I, Santander Alva V, Tanaka J. Effects of the COVID-19 pandemic on the prevalence of obsessive-compulsive symptoms among young adults in Peru. J Publ Hlth Dev. 2022 [acceso 01/08/2023];20(2):137-51. Disponible en: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/256325

19. Butun A, Hemingway P. A qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with minor illness. Int Emerg Nurs. 2018;36:56-62. DOI: https://doi.org/10.1016/j.ienj.2017.07.002

20. Akbayram HT, Coskun E. Paediatric emergency department visits for non-urgent conditions: Can family medicine prevent this? Eur J Gen Pract. 2020 [acceso 10/04/2024];26(1):134-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28778488

21. Kurt F, Beğde F, Oğuz S, Tekin D, Suskan E. How Important Are Parental Age and Educational Level in Nonurgent Admissions to the Pediatric Emergency Department? Pediatr Emerg Care. 2020 [acceso 01/04/2024];36(9):414-8. Disponible en: https://journals.lww.com/peconline/abstract/2020/09000/how_important_are_parental_age_and_educational.2.aspx

22. Smith V, Mustafa M, Grafstein E, Doan Q. Factors Influencing the Decision to Attend a Pediatric Emergency Department for Nonemergent Complaints. Pediatr Emerg Care. 2015;31(9):640-4. DOI: https://doi.org/10.1097/PEC.0000000000000392

23. Krebs LD, Kirkland SW, Chetram R, Nikel T, Voaklander B, Davidson A, et al. Low-acuity presentations to the emergency department in Canada: exploring the alternative attempts to avoid presentation. Emerg Med J. 2017;34(4):249-255. DOI: https://doi.org/10.1136/emermed-2016-205756

24. McLauchlan K, Ramlakhan S, Irving A. Why do parents present to the Paediatric Emergency Department with conditions suitable for management in less acute settings? A qualitative study. Eur J Emerg Med. 2020 [acceso 01/04/2024];27(1):40-5. Disponible en: https://journals.lww.com/euro-emergencymed/abstract/2020/02000/why_do_parents_present_to_the_paediatric_emergency.11.aspx

25. Platter MEM, Kurvers RAJ, Janssen L, Verweij MMJ, Barten DG. The impact of an emergency care access point on pediatric attendances at the emergency department: An observational study. Am J Emerg Med. 2020 [acceso 10/04/2024];38(2):191-197. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0735675719300804?via%3Dihub

26. Egan M, Murar F, Lawrence J, Burd H. Identifying the predictors of avoidable emergency department attendance after contact with the NHS 111 phone service: analysis of 16.6 million calls to 111 in England in 2015-2017. BMJ Open. 2020 [acceso 11/04/2024];10(3). Disponible en: https://bmjopen.bmj.com/content/10/3/e032043.long

27. Pehlivanturk-Kizilkan M, Ozsezen B, Batu ED. Factors Affecting Nonurgent Pediatric Emergency Department Visits and Parental Emergency Overestimation. Pediatr Emerg Care. 2022 [acceso 08/04/2024];38(6):264-8. Disponible en: https://journals.lww.com/peconline/abstract/2022/06000/factors_affecting_nonurgent_pediatric_emergency.4.aspx

Published

2025-03-18

How to Cite

1.
Galdos-Bejar M, Belanovic-Ramirez I, Diaz-Canales A, Toro-Huamanchumo CJ, Carreazo NY, Noel-Meza JP. Misuse of the Pediatric Emergency Service and COVID-19 pandemic lessons in Peru. Rev Cubana Pediatría [Internet]. 2025 Mar. 18 [cited 2025 Jun. 25];97. Available from: https://revpediatria.sld.cu/index.php/ped/article/view/7287