O0025: Parental Care-seeking Behaviors for Pediatric Acute Illnesses During the COVID-19 Pandemic in the Pediatric Emergency Department, Urgent Cares and Primary Care Sites

Background: The volume of Pediatric Emergency Department (PED) visits decreased significantly during the early COVID-19 pandemic. It is unclear if this was caused by delays in necessary care, changes in epidemiology due to confinement, shifts in site of care or decrease in visits for non-urgent or emergent conditions. We sought to characterize the changes in volumes and diagnoses for pediatric acute illnesses during the COVID-19 pandemic across PEDs, urgent cares (UC) and primary care pediatricians (PCP) to characterize differential care-seeking behaviors.

Methods: This was a retrospective study of 2 PEDs, 5 pediatric UCs, select hospital affiliated and private community PCPs in Cincinnati, Ohio. Unique patient visits were extracted from electronic medical records including patient demographics and visit characteristics and top billing diagnoses. Baseline data consisted of 3 years prior to pandemic, 2017-2019, and was compared to the pandemic time, January 2020 to September 2021. Volumes were collected as number of patient visits at a care site per month. PCP visits were screened for ill visits by excluding well child check CPT codes. We calculated the differences between baseline and pandemic volumes data. Top billing ICD-10 codes were transformed into clinically meaningful ICD-based diagnosis grouping system (DGS). Fisher exact tests were used to demonstrate proportionate changes in the top 15 pre-pandemic DGS compared to 2020 and 2021.

Results: Patient age, sex, race/ethnicity and insurance status were not different when comparing baseline to pandemic time periods across PED, UC and PCP sites. The PED and UC volumes decreased by 61% and 76%, respectively in in April 2020. PED volumes steadily increased from the April 2020 nadir and reached baseline levels in April 2021; UC reached baseline levels in May 2021. PED volumes then surpassed baseline volumes during July-August of 2021 by 19%. PCP ill visits declined by 56% in May 2020 at its nadir but quickly reaches baseline volumes June 2020. Proportion of PCP telehealth volumes significantly increased during the beginning of the pandemic in March-May of 2020 and during November 2020- January 2021. DGS representing acute viral or febrile illnesses proportionately decreased overall during the pandemic except for an increase during the summer months of 2021. There were also significant changes in patterns of psychiatric and behavior diseases & substance abuse, lacerations, amputations & uninfected foreign bodies (external), and fractures & dislocations (extremities) from baseline to pandemic times.

Conclusion: There were differences from pre-pandemic baseline and pandemic care-seeking behaviors of parents for pediatric acute illnesses with dramatic fluctuations in care volumes, likely as a combination of change in disease incidence due to social distancing measures, delayed care and preference for PCP office-based care corresponding with rise in community COVID-19 cases.