Advanced imaging of disease unrelated to the coronavirus disease 2019 (COVID-19) during the pandemic: effect of patient demographics in a pediatric emergency department

• Published in: Pediatric radiology Vol. 52; no. 9; pp. 1756 - 1764
• Main Authors: Jarrett, Delma Y., Kim, Wendy G., Johnston, Patrick R., Ward, Valerie L., Lee, Lois K., Brown, Stephen D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2022; Springer Nature B.V
• Subjects: Children; Computed tomography; Confidence intervals; Coronaviruses; COVID-19; Demographic variables; Demographics; Demography; Disease; Electronic health records; Electronic medical records; Emergency medical care; Emergency medical services; Fluoroscopy; Health care; Illnesses; Imaging; Medical imaging; Medicine; Medicine & Public Health; Minority & ethnic groups; Neuroradiology; Nuclear Medicine; Oncology; Original; Original Article; Pandemics; Patients; Pediatrics; Radiology; Regression analysis; Regression models; Statistical analysis; Trauma; Ultrasound; Viral diseases; Pediatrics; Emergency department; Coronavirus disease 2019; Race; Radiology; Children; Health care disparity
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-022-05357-z

Background
Coronavirus disease 2019 (COVID-19) disproportionately affected children from underrepresented minorities and marginalized populations, but little is understood regarding the pandemic’s effect on non-COVID-19-related illnesses.
Objective
To examine the effect of the COVID-19 pandemic and related stay-at-home orders on pediatric emergency department (ED) imaging of non-COVID-19-related diseases across patient demographic groups.
Materials and methods
We retrospectively reviewed radiology reports from advanced imaging (US, CT, MRI and fluoroscopy) on children in the ED during the month of April for the years 2017, 2018, 2019 and 2020, excluding imaging for respiratory illness and trauma. We used imaging results and the electronic medical record to identify children with positive diagnoses on advanced imaging, and whether these children were admitted to the hospital. Demographic variables included age, gender, race/ethnicity and insurance type. We used multivariable Poisson regression models to report rate ratio (RR) and binomial logistic regression models to report odds ratio (OR) with 95% confidence interval (CI).
Results
We included 1,418 ED encounters for analysis. Compared to pre-2020, fewer children underwent ED imaging in April 2020 (RR 0.63, 95% CI 0.52, 0.76). The odds of positive imaging results increased (OR 2.18, 95% CI 1.59, 3.00) overall, and for all racial/ethnic groups except Hispanic patients (OR 0.83, 95% CI 0.34, 2.03). No differences occurred in admission rates for positive imaging results in 2020 compared to pre-2020.
Conclusion
In April 2020 compared to pre-2020, there were decreased imaging and increased positivity rates for imaging for non-respiratory and non-trauma ED visits. COVID-19 stay-at-home advisories might have resulted in triaging for urgent health care by families or referring clinicians during this month of the pandemic.