Pattern of emergency department accesses before and during the Covid-19 pandemic [Profilo degli accessi pediatrici in Pronto Soccorso prima e durante la pandemia Covid-19]

Objectives. To evaluate how the characteristics of paediatric emergency department (ED) visits have changed during the SARS-CoV-2 pandemic. Methods. In a period of three months, from January 1 to March 31, for three consecutive years (2019, 2020 and 2021), paediatric accesses to the San Gerardo hospital's ED were evaluated. Sociodemographic data, information on the ED visit, the diseases that led to the ED access, and the outcome of the visit were extracted and analysed. Records were deidentified, and data were analysed using an anonymous subject code. χ2 for trend test was used for comparing the characteristics of the accesses in the 3 trimesters. Results. The overall number of ED visits decreased from 4,106 to 1,193 (-71%) over time. Independently of the observation period, the majority of visits had a low priority code (93% in 2019 and 97% in 2021), while in 2021 35% of accesses were potentially avoidable. The rate of hospitalisation after the visit increased from 10% to 18%. Upper respiratory tract infections were the most common reason for ED attendance in all the trimesters, but their prevalence decreased from 33 to 16%. On the contrary, visits for psychiatric disorders increased from 2% in 2019 to 9% in 2021. Conclusions. Despite the decrease in number of ED visits during the pandemic period, and the increase in hospitalisation rate, most of the accesses during the first trimester of 2021 were also non-urgent and one-third were potentially avoidable, underlying the need of interventions aimed at reducing the inappropriate use of the ED.