Across the world attendance to Children’s Emergency Departments fell during the early stages of the COVID pandemic

However is this the case for all pandemics? To answer this question the group behind EPISODES (a multinational retrospective cohort study comparing the type of presentations, severity, and the outcomes of children presenting to emergency departments during the SARS-CoV-2 pandemic with historical data) undertook a systematic review of the influence of epidemics and pandemics on children’s ED use.

There have been 5 disease outbreaks since 2005 which have been classified as public health emergencies of international concern by the World Health Organisation. 

The findings demonstrated the disproportionate nature of research into COVID compared to other epidemics. Of 131 papers, 104 were related to COVID, with 16 for H1N1. There were then no more than 4 articles each on other epidemics.

There were large differences in paediatric emergency service utilization, while COVID significantly reduced attendance, the H1N1 wave increase attendance. An interesting finding was that differences between countries were likely related to the number of publications from that given country and the length of time of that study (it was noted that studies undertaken over a longer period of time showed less change than those that were more snap surveys).

Changing emergency care attendance was likely related to the public health response and parent/carer concern about the severity of the disease process. Of most importance, our review demonstrated significant inequity in publications from high versus low-income countries and this discrepancy should be prioritized for relevant interventions during future pandemics.