Top 5 Takeaways

1. Significant Decline in Visits: Pediatric emergency department (ED) visits decreased by 51% in 2020, 22% in 2021, and 23% in January 2022 compared to 2019.
2. COVID-19 Predominance: COVID-19-related visits were the most common across all pediatric age groups, while visits for other respiratory illnesses generally declined.
3. Increased Visits for Certain Conditions: There was an increase in visits for injuries (e.g., firearm injuries, self-harm, drug poisonings), some chronic diseases, and behavioral health concerns, with variations by age group.
4. Impact of Delayed Care: Health care providers and families need to be vigilant for indirect impacts of the pandemic, including conditions resulting from delayed care and increased emotional distress among children and adolescents.
5. Behavioral Health Concerns: Visits related to behavioral health concerns increased, particularly among older children and adolescents, highlighting the need for comprehensive prevention strategies.

Original Article Author and Citation

Corresponding Author

Lakshmi Radhakrishnan, LRadhakrishnan@cdc.gov

Suggested Citation

Radhakrishnan L, Carey K, Hartnett KP, et al. Pediatric Emergency Department Visits Before and During the COVID-19 Pandemic — United States, January 2019–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:313–318. DOI: http://dx.doi.org/10.15585/mmwr.mm7108e1

Summary

This report examines changes in pediatric emergency department (ED) visit trends in the United States from January 2019 to January 2022. The study found a significant decline in overall pediatric ED visits during the COVID-19 pandemic, with a 51% decrease in 2020, 22% in 2021, and 23% in January 2022 compared to 2019. While COVID-19-related visits were predominant, visits for other respiratory illnesses mostly declined. However, there was an increase in visits for certain injuries, chronic diseases, and behavioral health concerns, varying by age group.

Methods

Data from the National Syndromic Surveillance Program (NSSP) were analyzed for three periods: March 15, 2020–January 2, 2021 (2020), January 3, 2021–January 1, 2022 (2021), and January 2, 2022–January 29, 2022 (January 2022), and compared with corresponding weeks in 2019. The analysis included pediatric ED visits for children aged 0–17 years, categorized by age groups (0–4, 5–11, and 12–17 years) and visit diagnoses. The Healthcare Cost and Utilization Project (HCUP) Clinical Classifications Software Refined (CCSR) tool was used to group ICD-10-CM codes into diagnostic categories. The study focused on categories with significant changes in mean weekly visits and visit ratios (VRs).

Discussion

The decline in pediatric ED visits during the pandemic may be attributed to parents’ and caregivers’ risk perception and avoidance of EDs. Despite the overall decline, visits for COVID-19 and related screenings increased, particularly during the circulation of the Omicron variant. The study also noted elevated proportions of visits for certain chronic conditions and injuries, suggesting delayed care and increased behavioral health concerns among children and adolescents. Comprehensive prevention strategies and vigilant monitoring are essential to address these indirect impacts of the pandemic.

Conclusion

Health care systems should be aware of the indirect effects of delayed medical care and maintain vigilance for signs of exacerbated emotional distress and behavioral health concerns among children and adolescents. Prevention programs that improve physical and mental health are critical during and after emergencies. Reducing COVID-19 infection through vaccination and other nonpharmaceutical prevention strategies can further protect pediatric health.

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