Auswirkungen der Corona Pandemie auf die Notfallversorgung im Kindesalter und die zeitliche Entwicklung im Verlauf der Pandemie.

Zusammenfassung

Hintergrund Die COVID-19 Pandemie hat zu massiven gesellschaftlichen und wirtschaftlichen Einschränkungen geführt. Im Kindesalter wurden elektive Vorsorgeuntersuchung oftmals nicht wahrgenommen und es zeigte sich eine Reduktion der Zahl der Notfallvorstellungen.

Material und Methoden In einer retrospektiven Studie erfolgte eine quantitative Auswertung aller Notfallpatienten der 5 Kindernotaufnahmen Hamburgs und der Kinder- und Jugendarztpraxen der Jahre 2019 und 2020. Zusätzlich erfolgte die detaillierte Analyse der Notfallbehandlungen des Altonaer Kinderkrankenhauses während der ersten Phase der Pandemie im Vergleich zum Vorjahr. Zusammenhänge zu den Eckpunkten der Pandemieentwicklung wurden analysiert. Die Berechnung signifikanter Unterschiede in Bezug auf die demographischen Daten und Krankheitsbilder erfolgte mittels Chi- Quadrat und t-Test.

Ergebnisse In allen 5 pädiatrischen Notaufnahmen Hamburgs zeigte sich eine nahezu gleichförmige Abnahme der Patientenvorstellungen während der Pandemie, ähnlich in den Kinder- und Jugendarztpraxen. Die Zahl der Behandlungen verhielt sich dabei nicht streng gegenläufig zu den Neuinfektionen, sondern korreliert eher mit den Mobilitätsdaten und entsprach somit den gesamtgesellschaftlichen Veränderungen. Während der Pandemie stieg der Anteil häuslicher Unfälle an der Gesamtzahl der Vorstellungen signifikant an. Die Analyse der Diagnosen zeigte unter anderem eine relative Abnahme von (viralen) Infektionskrankheiten. Nicht behandlungspflichtige Erkrankungen führten in der Pandemie seltener zur Vorstellung. Diese Phänomene entlasteten einerseits die Notaufnahmen, bergen aber auch die Gefahr, dass Erkrankungen durch Eltern falsch eingeschätzt werden und eine notwendige ärztliche Vorstellung somit zu spät erfolgt.

Abstract

Background The COVID-19 pandemic resulted in massive societal and economic constraints. In childhood, elective screening was often not attended and there was a reduction in the number of emergency presentations.

Material and Methods In a retrospective study, a quantitative evaluation of all emergency patients of the 5 pediatric emergency departments and all pediatricians’ practices of Hamburg in 2019 and 2020 was performed. In addition, a detailed evaluation of the emergency treatments of the Altona Children's Hospital during the first phase of the pandemic in the course of 2020 compared to the previous year was performed. Correlations to the key points of the pandemic development were analyzed. Chi-square and t-test were used to calculate significant differences in demographic data and disease patterns.

Results All 5 pediatric emergency departments in Hamburg showed an almost uniform pandemic-related decrease in patient presentations, the findings were similar in pediatric practices. The number of presentations did not strictly counteract the number of new infections, but rather correlated with the mobility data and thus corresponded to the overall societal changes. During the pandemic, the proportion of domestic accidents increased significantly. Analysis of diagnoses showed, among other things, a relative decrease in (viral) infectious diseases. Illnesses not requiring treatment came to presentation less frequently during the pandemic. On the one hand, these phenomena relieve the emergency departments, but they also harbor the risk that parents will misjudge illnesses and that a necessary medical presentation will be made too late.

Schlüsselwörter

COVID-19 - Pädiatrie - Kinderchirurgie - Notaufnahme - Lockdown - Hamburg

Key words

COVID-19 - pediatrics - pediatric surgery - emergency room - lockdown - Hamburg

Publication History

Article published online:
16 September 2021

• References

• 1 Bundesregierung, “Der Beschluss von der Bundes-Regierung und den Bundes-Ländern zur Bekämpfung der Corona-Pandemie,” 30.11.2020 2020
• 2 Bundesregierung, “Telefonkonferenz der Bundeskanzlerin mit den Regierungschefinnen und Regierungschefs der Länder am 13. Dezember 2020,” 13.12.2020 2020
• 3 Casalino E, Choquet C, Bouzid D. et al. “Analysis of emergency department visits and hospital activity during influenza season, COVID-19 epidemic, and lockdown periods in view of managing a future disaster risk: A multicenter observational study,”. Int J Environ Res Public Health 2020; 17: 1-15 DOI: 10.3390/ijerph17228302.
• 4 Chang HJ, Huang N, Lee CH. et al. “The Impact of the SARS Epidemic on the Utilization of Medical Services: SARS and the Fear of SARS,”. Am J Public Health 2004; 94: 562-564 DOI: 10.2105/AJPH.94.4.562.
• 5 Even L, Lipshaw MJ, Wilson PM. et al. “Pediatric emergency department volumes and throughput during the COVID-19 pandemic,”. Am J Emerg Med. 2020 DOI: 10.1016/j.ajem.2020.09.074
• 6 Giamello JD, Abram S, Bernardi S. et al. “The emergency department in the COVID-19 era. Who are we missing?,”. Eur J Emerg Med 2020; 27: 305-306 DOI: 10.1097/MEJ.0000000000000718.
• 7 Goldman RD, Grafstein E, Barclay N. et al. “Paediatric patients seen in 18 emergency departments during the COVID-19 pandemic,”. Emerg Med J. 2020 37. 773-777 DOI: 10.1136/emermed-2020-210273
• 8 Hetkamp M, Schweda A, Bäuerle A. et al. “Sleep disturbances, fear, and generalized anxiety during the COVID-19 shut down phase in Germany: relation to infection rates, deaths, and German stock index DAX,”. Sleep Med 2020; 75: 350-353 DOI: 10.1016/j.sleep.2020.08.033.
• 9 Hunter JD. “Matplotlib: A 2D graphics environment,”. Comput Sci Eng 2009; 9: 90-95 DOI: 10.1109/MCSE.2007.55.
• 10 Jones JH, Salathé M. “Early assessment of anxiety and behavioral response to novel swine-origin influenza a(H1N1),”. PLoS One 2009; 4: e8032 DOI: 10.1371/journal.pone.0008032.
• 11 Kinross P, Suetens C, Dias JG. et al. “Rapidly increasing cumulative incidence of coronavirus disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020,”. Eurosurveillance 2020; 25 DOI: 10.2807/1560-7917.ES.2020.25.11.2000285.
• 12 Lau JTF, Griffiths S, Choi KC. et al. “Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong,”. BMC Infect Dis. 2010 10. 139 DOI: 10.1186/1471-2334-10-139
• 13 Lazzerini M, Barbi E, Apicella A. et al. “Delayed access or provision of care in Italy resulting from fear of COVID-19,”. Lancet Child Adolesc Heal 2020; 4: E10-E11 DOI: 10.1016/S2352-4642(20)30108-5.
• 14 Madanelo M, Ferreira C, Nunes-Carneiro D. et al. “The impact of the coronavirus disease 2019 pandemic on the utilisation of emergency urological services,”. BJU Int 2020; 126: 256-258 DOI: 10.1111/bju.15109.
• 15 Mantica G, Riccardi N, Terrone C. et al. “Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear,”. Public Health 2020; 183: 40-41 DOI: 10.1016/j.puhe.2020.04.046.
• 16 McDonnell T, Nicholson E, Conlon C. et al. “Assessing the impact of COVID-19 public health stages on paediatric emergency attendance,”. Int J Environ Res Public Health 2020; 17: 6719 DOI: 10.3390/ijerph17186719.
• 17 Metzler B, Siostrzonek P, Binder RK. et al. “Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage,”. Eur. Heart J. 2020; 41: 1852-1853 DOI: 10.1093/eurheartj/ehaa314.
• 18 NDR “Coronavirus in Hamburg: UKE-Arzt erkrankt,”. 2020
• 19 Nicholson E, McDonnell T, De Brún A. et al. “Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare-systematic review,”. BMC Health Serv Res 2020; 20: 663 DOI: 10.1186/s12913-020-05527-5.
• 20 Nicholson E, Mc Donnell T, Conlon C. et al. “Parental Hesitancy and Concerns around Accessing Paediatric Unscheduled Healthcare during COVID-19: A Cross-Sectional Survey,”. Int J Env Res Public Heal 2020; 17: 9264 DOI: 10.3390/ijerph17249264.
• 21 Nuñez JH, Sallent A, Lakhani K. et al. “Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain,”. Injury 2020; 51: 1414-1418 DOI: 10.1016/j.injury.2020.05.016.
• 22 Patrick SW, Henkhaus LE, Zickafoose JS. et al. “Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey,”. Pediatrics 2020; 146: e2020016824 DOI: 10.1542/peds.2020-016824.
• 23 Research on Complex Systems - Robert Koch Institut & Humboldt Universität zu Berlin “Covid-19 Mobility Project,”. 2020 https://www.covid-19-mobility.org. Stand 21.06.2021
• 24 Robert Koch-Institut “Nationale Plattform für geographische Daten (NPGEO Corona Hub),”. 2020 https://npgeo-corona-npgeo-de.hub.arcgis.com Stand 21.06.2021
• 25 Robert Koch Institut “Täglicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19) 10.12.2020,”. 2020
• 26 Schlosser F, Maier BF, Jack O. et al. “COVID-19 lockdown induces disease-mitigating structural changes in mobility networks,”. Proc Natl Acad Sci U. S. A. 2020; 117: 32883-32890 DOI: 10.1073/pnas.2012326117.
• 27 Senatskanzlei Hansestadt “Allgemeinverfügung zur Eindämmung des Coronavirus in Hamburg,”. 2020
• 28 Sohrabi C, Alsafi Z, O’Neill N. et al. “World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19),”. Int J Surg 2020; 76: 71-76 DOI: 10.1016/j.ijsu.2020.02.034.
• 29 Tam CCF, Cheung KS, Lam S. et al. “Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China,”. Circ Cardiovasc Qual. Outcomes 2020; 13 DOI: 10.1161/CIRCOUTCOMES.120.006631.
• 30 Virtanen P, Gommers R, Oliphant TE. et al. “SciPy 1.0: fundamental algorithms for scientific computing in Python,”. Nat Methods. 2020 17. 261-272 DOI: 10.1038/s41592-019-0686-2