{"pk":15437,"title":"Visits to the Pediatric Emergency Department for Eye Conditions Before and During the COVID-19 Pandemic","subtitle":null,"abstract":"Introduction:\n The use of the emergency department (ED) has been increasing, and many visits occur for non-urgent conditions. A similar trend was found among adult visits to the ED for ocular conditions. In this study we analyzed the impact of sociodemographic factors, presentation timing, and the COVID-19 pandemic on pediatric ED (PED) encounters for ophthalmologic conditions. It is important to identify the multifold factors associated with overutilization of the ED for non-urgent conditions. Caring for these patients in an outpatient clinical setting is safe and effective and could decrease ED crowding; it would also prevent delays in the care of other patients with more urgent medical problems and lower healthcare costs.\nMethods:\n We retrospectively reviewed electronic health records of PED ocular-related encounters at two children’s hospitals before (January 2014-May 2018) and during the COVID-19 pandemic (March 2020-February 2021). Encounters were categorized based on the International Classification of Diseases codes into “emergent,” “urgent,” and non-urgent” groups. We analyzed associations between sociodemographic factors and degrees of visit urgency. We also compared visit frequencies, degrees of urgency, and diagnoses between pre-pandemic and pandemic data. \nResults:\n Pre-pandemic ocular-related PED encounters averaged 1,738 per year. There were highly significant sociodemographic associations with degrees of urgency in PED utilization. During the 12-month pandemic timeframe, encounter frequency contracted to 183. Emergent visits decreased from 21% to 11%, while the proportions of urgent and non-urgent encounters were mostly unchanged. The most common pre-pandemic urgent diagnosis was corneal abrasion (50%), while visual disturbance was most common during the pandemic (92%). During both time periods, eye trauma was the most frequent emergent encounter and conjunctivitis was the most common non-urgent encounter. \nConclusion:\n Sociodemographic factors may be associated with different types of PED utilization for ocular conditions. Unnecessary visits constitute major inefficiency from a healthcare-systems standpoint. The marked decrease in PED utilization and differing proportions of ocular conditions encountered during the pandemic may reflect a decrease in incidence of many of those conditions by social distancing; these changes may also reflect altered parental decisions about seeking care.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"pediatric emergency"},{"word":"ocular condition"},{"word":"emergent"},{"word":"urgent"},{"word":"non-urgent"}],"section":"Pediatrics","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4t91p6g0","frozenauthors":[{"first_name":"Jing","middle_name":"","last_name":"Jin","name_suffix":"","institution":"Nemours Children’s Hospital, Division of Ophthalmology, Wilmington, Delaware","department":"None"},{"first_name":"Lauren","middle_name":"","last_name":"Bules","name_suffix":"","institution":"Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Kaynan","middle_name":"","last_name":"Doctor","name_suffix":"","institution":"Nemours Children’s Hospital, Division of Emergency Services, Wilmington, Delaware","department":"None"},{"first_name":"Dorothy","middle_name":"","last_name":"Hendricks","name_suffix":"","institution":"Nemours Children’s Hospital, Division of Ophthalmology, Wilmington, Delaware","department":"None"},{"first_name":"Katherine","middle_name":"","last_name":"Callaghan","name_suffix":"","institution":"Nemours Children’s Hospital, Department of Pediatrics, Wilmington, Delaware","department":"None"},{"first_name":"Julia","middle_name":"E.","last_name":"Reid","name_suffix":"","institution":"Children’s Hospital of Philadelphia, Division of Ophthalmology, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Jonathan","middle_name":"","last_name":"Salvin","name_suffix":"","institution":"Nemours Children’s Hospital, Division of Ophthalmology, Wilmington, Delaware","department":"None"},{"first_name":"Sharon","middle_name":"","last_name":"Lehman","name_suffix":"","institution":"Nemours Children’s Hospital, Division of Ophthalmology, Wilmington, Delaware","department":"None"},{"first_name":"Airaj","middle_name":"","last_name":"Fasiuddin","name_suffix":"","institution":"Nemours Children’s Hospital, Division of Ophthalmology, Orlando, Florida","department":"None"},{"first_name":"Joseph","middle_name":"","last_name":"Piatt","name_suffix":"","institution":"Nemours Children’s Hospital, Division of Neurosurgery, Wilmington, Delaware","department":"None"}],"date_submitted":"2021-05-26T19:17:53Z","date_accepted":"2021-05-26T19:17:53Z","date_published":"2022-03-24T20:57:57Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/15437/galley/7792/download/"}]}