| Objective:To investigate the characteristics of changes in the spectrum of pediatric emergency department(ED)under the background of COVID-19 epidemic,analyze the change of medical behavior in pediatric Ed under the background of Covid-19,so as to provide reference for rational allocation of pediatric emergency personnel and scientific reserve of emergency medical supplies,and provide reference for similar major public health emergencies in the future.Methods:Clinical data such as number of visits,gender,age,way of coming to the hospital,disease classification,time of visit,destination,disease diagnosis and ICD of children who visited the emergency department of Jiangxi children’s hospital from January 1,2019 to December 31,2021 were collected.The outbreak of COVID-19 was taken as the time cut-off point,They were divided into the control group(2019 group)and the observation group(2020 group,2021 group)for retrospective investigation and analysis.Results:1.Number of visits:the number of visits in the ED of the hospital in 2019,2020and 2021 was 127461,93664 and 107743 respectively,with a year-on-year decrease of 26.15%in 2020 and 15.47%in 2021 compared with 2019.Among them,the number of children with Grade I and II critical illness in 2019,2020 and 2021 was3069,2674 and 2053 respectively,accounting for 2.41%,2.86%and 1.90%of the number of the whole patients in the emergency department in the same year.The composition ratio of the three groups was statistically significant(χ~2=188.44,P<0.01);From February 1,2020 to December 31,2021,82108 patients were admitted to the fever clinic outside 8 hours,accounting for 43.03%of the 190816 patients in emergency department during the same period.2.Gender:A total of 328,868 children were enrolled,including 203524 males and 125344 females,with a male/female sex ratio of 1.62/1.There was no significant difference in the male/female sex ratio between the observation group and the control group.The sex ratio of accidental injury was 1.74/1,which was significantly different from that of the total number of children in emergency department(χ~2=42.92,P<0.01).3.Age:More than 80%of emergency children are younger than 6 years old.The average age of children in emergency department was(40.1±36.0)months in2019 group,(40.2±37.0)months in 2020 group,and(43.2±37.2)months in 2021group.There was a statistically significant difference in the average age of the three groups(F=248.60,P<0.01).4.Methods of hospitalization:In 2019,2020 and 2021,there were 3332,2659and 1798 visits by pre-hospital emergency treatment,which accounted for 2.61%,2.84%and 1.67%of the visits by emergency department in the same year,respectively,and the difference in the constituent ratio among the three groups was statistically significant(χ~2=351.00,P<0.01).5.Whereabouts after treatment:There were 21312 hospitalized children in 2019,15124 in 2020,and 12368 in 2021,accounting for 16.72%,16.16%,and 11.48%of emergency department visits in the same year respectively,and there was a statistical difference in the constituent ratio among the three groups(χ~2=1447.59,P<0.01).6.Visit month and time:the first visit peak month of the three groups was January,the second visit peak month of the control group and the 2021 group was May,and the second visit peak month of the 2020 group was October.The first peak visit time was 12:00 to 13:00 in the daytime emergency department,and the second peak visit time was 22:00 to 23:00 in the night emergency department.After the epidemic,the peaks of the two peak visits in the 2020 group and 2021 group were relatively flat compared with those before the epidemic.7.Disease Spectrum:The top five in the control group(2019 group)were respiratory disease(J00-J99)76894(60.33%),accidental injury(S00-T98)11217(8.80%),digestive system disease(K00-K93)11188(8.78%),infectious and parasitic diseases(A00-B99)5609(4.40%),unclear diagnosis(R00-R99)4469(3.51%).In 2020 group,the top five groups were respiratory diseases(J00-J99)41181(43.97%),accidental injuries(S00-T98)14317(15.29%),digestive diseases(K00-K93)10437(11.14%),factors affecting health status and contact with health care institutions(Z00-Z99)5178(5.53%),and unclear diagnosis(R00-R99)4848(5.18%);In 2021 group,respiratory system diseases(J00-J99)47546(44.13%),accidental injuries(S00-T98)15439(14.33%),digestive system diseases(K00-K93)13911(12.91%),factors affecting health status and contact with health care institutions(Z00-Z99)6734(6.25%),unclear diagnosis(R00-R99)6258(5.81%)were ranked in the top five groups;The top five critical diseases in 2019 and 2020group were both bronchopneumonia,febrile convulsion,neonatal pneumonia,central nervous system infection and status epilepticus.The top five ranks of critical diseases in 2021 group were febrile convulsion,bronchopneumonia,neonatal pneumonia,central nervous system infection,and epileptic status.The incidence and constituent ratio of surgical traumatic diseases in critical patients showed an increasing trend after the epidemic.8.Characteristics of the early stage of the epidemic:In the early stage of the epidemic(from January 24,2020 to April 8,2020),a total of 10148 patients were treated in the emergency department,a decrease of 67.58%compared with 2019.There were 6401 males and 3747 females,with a male/female sex ratio of 1.71/1,which was statistically significant compared with the overall sex ratio of children in emergency department(1.62/1)(χ~2=5.91,P=0.015).The proportion of pre-hospital emergency care in the early stage of the epidemic(5.60%)was significantly higher than that in the same period of 2019 and 2021,and the difference was statistically significant(χ~2=325.24,P<0.01).The proportion of critical cases in the early stage of the epidemic(4.16%)was higher than that in the same period of 2019 and 2021,and the difference was statistically significant(χ~2=103.27,P<0.01).At the beginning of the outbreak,the proportion of traumatic diseases increased and respiratory diseases decreased significantly.Conclusions:1.Males are more than females in pediatric emergency department,especially in accidental injury diseases.2.More than 80%of emergency children are younger than 6 years old,and the age of emergency children is on the rise after the epidemic.3.There are two peak months and two peak hours in pediatric emergency department.It should arrange enough medical personnel at corresponding time and make emergency plans.4.After the epidemic,the number of emergency visits decreased,among which respiratory diseases decreased significantly,infectious diseases,nervous system diseases and perinatal diseases decreased at the same time.Accidental injuries showed an obvious increasing trend,digestive and urinary diseases are on the rise.5.Critical diseases in emergency departments are focused on respiratory and nervous system diseases,and surgical traumatic diseases showed an increasing trend in critical diseases after the epidemic.It is required that pediatric emergency departments should be equipped with professional trauma teams and emergency equipment so as to gain precious time for critically injured children. |
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