Parents faced longer wait times and repeat visits to emergency departments (EDs) for pediatric respiratory illnesses in the fall of 2022, according to a study yesterday based on Michigan data and published in JAMA Network Open.
In the fall of 2022, many hospitals and clinics across the country reported a surge of pediatric respiratory illness, fueled by influenza, respiratory syncytial virus (RSV), and COVID-19.
During 2020 and 2021, COVID-19 mitigation efforts had limited the spread of seasonal viruses by as much as 40%, the authors wrote.
"To date little research has described how health system strain affects acute care for children with viral and respiratory conditions across diverse hospital-based EDs," the authors explained. They used the metrics of ED wait times, ED length of stay (LOS), and ED revisits to examine how the viral surge affected pediatric emergency department visits in 25 Michigan EDs from September 1 through December 31, 2022.
Prolonged wait times were defined as more than 4 hours, and prolonged ED LOS was defined as more than 12 hours.
Surge bought a 70% increase in cases
There were 301,688 pediatric visits for viral and respiratory illness at the 25 EDs included in the study during that time frame, an increase of 71.8% over the 4 preceding months and 15.7% over the same period in 2021.
The authors said that, in all hospitals, the surge began in September and peaked in the later weeks of November. Highest-volume days at children's EDs were associated with increased wait times longer than 4 hours (odds ratio [OR], 4.09; 95% confidence interval [CI], 3.79 to 4.42), LOS longer than 12 hours (OR, 1.37; 95% CI, 1.26 to 1.48), and ED revisits (OR, 1.40; 95% CI, 1.28 to1.53).
In rural children's EDs revisits resulted in hospital admission 9.7% of the time, while at children's hospitals 26.2% of ED revisits resulted in hospitalization.
The odds of wait times longer than 4 hours and LOS longer than 12 hours for ED visits were greater during the surge at children's hospitals (adjusted ORs [aORs], 51.43 [95% CI, 37.76 to 70.04] and 3.82; [95% CI, 3.44 to 4.26], respectively), urban sites with low pediatric volume (aORs, 10.24 [95% CI, 7.13-14.71] and 1.02 [95% CI, 0.82-1.25], respectively), and rural EDs (aORs, 5.17 [95% CI, 3.42-7.81] and 1.85 [95% CI, 1.53-2.22], respectively) compared with urban sites with high pediatric volume.
Revisits were more common in rural children's hospitals than urban settings. In total, 42 per 1,000 visits at children’s hospitals were resists during the study period.
Children's hospitals exhibited stronger associations between visit volumes and these measures and with greater overall burden of operational strain.
"Children's hospitals exhibited stronger associations between visit volumes and these measures and with greater overall burden of operational strain," the authors wrote.
"Insofar as children's hospitals are responsible for a growing proportion of inpatient care in the state, including accepting transfers from outlying sites, this may explain the bottleneck affecting wait times and LOS at those sites. At the same time pediatric volumes are growing, other sites may be experiencing decline or stable ED volumes for adult patients, permitting some flexibility to manage a surge in pediatric ED visits."
