Scientific Letter
Role of the pediatric emergency department during SARS-CoV-2 pandemic
Papel del pediatra de urgencias durante la pandemia por SARS-CoV-2
Cristina Parra Cotandaa,
, Ana Muñoz Lozónb, Eva Botifoll Garcíac,d, Grupo de Trabajo de Catástrofes e Incidentes con Múltiples Víctimas de la Sociedad Española de Urgencias Pediátricas (SEUP) 1
Corresponding author
a Servicio de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
b Urgencias de Pediatría, Servicio de Pediatría, Hospital Universitario Infanta Leonor, Madrid, Spain
c Urgencias de Pediatría, Servicio de Pediatría, Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
d Althaia, Xarxa Assistencial i Universitaria de Manresa, Manresa, Barcelona, Spain
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Universitario Infanta Leonor, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Urgencias de Pediatría, Servicio de Pediatría, Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Althaia, Xarxa Assistencial i Universitaria de Manresa, Manresa, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel del pediatra de urgencias durante la pandemia por SARS-CoV-2" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the paediatric population has been generally benign, contrary to the significant morbidity and mortality observed in the adult population that overwhelmed the Spanish health care system in Spring 2020<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. During this first wave of the pandemic, the activity of paediatricians changed not only in terms of the care delivered to the paediatric population, but also in that they had to manage adult patients with illness of varying severity<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">For this reason, the Working Group on Disasters and Multiple Casualty Incidents of the Sociedad Española de Urgencias Pediátricas (Spanish Society of Paediatric Emergency Medicine, SEUP) designed a study with the following objectives: (1) to describe the role of paediatric emergency physicians in the first wave of the coronavirus disease 2019 (COVID-19) pandemic, and (2) to define the new training needs of paediatricians to be ready for potential successive surges in cases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The working group designed a prospective survey-based study focused on paediatricians with regular and/or on-call shifts in paediatric emergency departments (PEDs) of hospitals affiliated to the SEUP. We developed an anonymous questionnaire in Spanish to collect data on epidemiological characteristics of the participants (age, sex, years of experience in emergency department and infection by SARS-CoV-2), hospital characteristics (type and level of care), professional activity during the pandemic (work setting, schedule, type of patients and training needs) and subjective experience of the early months of the pandemic (dichotomous questions about the fear of falling sick and transmitting the virus to household members, anxiety, being overwhelmed, information overload).</p><p id="par0020" class="elsevierStylePara elsevierViewall">In June and July 2020, we sent 3 electronic mails to the directors of 85 PEDs asking them to distribute the questionnaire to paediatricians in the permanent staff or covering on-call shifts in their department. The study was approved by the ethics committees of the 3 hospitals that employed the principal investigators.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We received 104 responses to the questionnaire corresponding to 25 PEDs (29.4% of the hospitals invited to participate), of which 80.8% (84) were submitted by female respondents. The median age of participants was 41.5 years (interquartile range [IQR], 34-49,2) and the median work experience in the paediatric emergency setting was 10 years (IQR, 4–15). Of all paediatricians, 57.7% (60) worked in general hospitals and 42.3% (44) in specialised children’s hospitals, 59.6% (62) worked in third-level hospitals, 33.6% (35) in second-level hospitals and 6.7% (7) in first-level hospitals, and participating hospitals received a median of 40 000 visits a year (IQR, 29 500−55 000). Of all respondents, 16.3% (17) had SARS-CoV-2 infection (of who 1 required hospital admission) and 12.5% (13) had to isolate at home.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Forty-one paediatricians (39.4%) had to move to a different work setting and 48 (46.2%) managed adult patients for varying amounts of time: less than a week (11; 22.9%), 1–4 weeks (11, 22.9%), 4–8 weeks (25, 52.1%) and more than 8 weeks (1; 2%). When it came to disease severity in the adult patients managed by paediatricians, 15 (31.2%) managed stable, 25 (52.1%) managed moderately ill patients and 8 (16.7%) managed patients with severe or life-threatening disease.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Seventy-one (68.3%) of the paediatricians that participated in the study believed they need additional training in the fields of internal medicine (59.2%), intensive medicine (26.8%), emergency care (8.4%) and pulmonology (5.6%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Paediatricians reported experiencing anxiety (76; 73.1%), fear of becoming ill (67; 64.4%) and worry about transmitting the infection to household members (91; 87.5%), feeling overwhelmed (30; 28.8%) and information overload (97; 93.3%). Twenty paediatricians (19.2%) required anti-anxiety and/or antidepressant drugs.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The risk factors for anxiety identified in the survey were employment in a general hospital (81.7% of paediatricians in general hospital with anxiety vs 61.4% of paediatricians in specialised hospitals; <span class="elsevierStyleItalic">P</span> = .038; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.2–6.8) and younger age (median of 39.5 years in paediatricians with anxiety vs 45 years in paediatricians without anxiety; <span class="elsevierStyleItalic">P</span> = .004; OR, 0.94; 95% CI, 0.89−0.98). We did not find statistically significant differences based on other factors (sex, change of work setting, management of adult patients, infection by SARS-CoV-2).</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition to the intrinsic limitations of survey-based studies, participation was voluntary, which could have been a source of significant bias. On the other hand, the impact of the first wave of the pandemic probably varied between PEDs in different geographical areas, affecting health care staff differently.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the first wave of the SARS-CoV-2 pandemic, nearly half of paediatricians had to change work settings and manage adult patients with disease of varying severity, and many experienced anxiety and fear of getting infected. All of this must be taken into account in the planning of PEDs in upcoming months, when there will likely be additional waves of the pandemic and the activity of paediatric emergency physicians will be changing.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">This research did not receive any external funding.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "xack582514" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-14" "fechaAceptado" => "2020-11-30" "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The members of the Working Group on Disasters and Incidents with Multiple Victims of the Spanish Society of Pediatric Emergencies (SEUP) are presented in Appendix A.</p>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Parra Cotanda C, Muñoz Lozón A, Botifoll García E. Papel del pediatra de urgencias durante la pandemia por SARS-CoV-2. An Pediatr (Barc). 2022;96:64–65.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0070" class="elsevierStylePara elsevierViewall">Andina Martinez, David; Botifoll García, Eva; Clerigué Arrieta, Nuria; de la Peña Garrido, Agustín; Bueno Barriocanal, Marta; Gilabert Iriondo, Nuria; Guerrero Márquez, Gloria; Lázaro Carreño, Maribel; Martínez Mejías, Abel; Miguez Navarro, Conchita; Muñoz Lozon, Ana; Murillo Pozo, María Angeles; Parra Cotanda, Cristina; Ranera Malga, Adrián; Rebordosa Martínez, Mónica; Rodrigo García, Rocío; Rodriguez Ortiz, Agustin; Ruperez García, Eva and Solano Navarro, Carmen.</p>" "etiqueta" => "Appendix A" "titulo" => "Members of the Working Group on Disasters and Multiple Casualty Incidents of the Sociedad Española de Urgencias Pediátricas (SEUP)" "identificador" => "sec0010" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Zimmermann" 1 => "N. Curtis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/INF.0000000000002660" "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2020" "volumen" => "39" "paginaInicial" => "355" "paginaFinal" => "368" "itemHostRev" => array:3 [ "pii" => "S0140673614609582" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why is COVID-19 so mild in children?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Brodin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apa.15271" "Revista" => array:6 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2020" "volumen" => "109" "paginaInicial" => "1082" "paginaFinal" => "1083" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32212348" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Children’s hospitals caring for adults during a pandemic: pragmatic considerations and approaches" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Jenkins" 1 => "L. Ratner" 2 => "A. Caldwell" 3 => "N. Sharma" 4 => "A. Uluer" 5 => "C. White" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12788/jhm.3432" "Revista" => array:7 [ "tituloSerie" => "J Hosp Med" "fecha" => "2020" "volumen" => "15" "paginaInicial" => "311" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32379039" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204515000832" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How strong is the duty to treat in a pandemic? Ethics in practice: point-counterpoint" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.J. Redmann" 1 => "A. Manning" 2 => "A. Kennedy" 3 => "J.H. Greinwald" 4 => "A. deAlarcon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0194599820930246" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2020" "volumen" => "163" "paginaInicial" => "325" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32450750" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack582514" "titulo" => "Acknowledgments" "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">We thank the staff of the hospitals that participated in the questionnaire: Althaia Xarxa Universitària in Manresa, Complejo Asistencial de Zamora, Complejo Hospitalario de Navarra, Hospital Materno-Infantil de Granada, Hospital Blanes and Hospital Calella, Hospital Clínico San Cecilio and Hospital Materno Infantil Granada, Hospital de Mendaro, Hospital Gregorio Marañón, Hospital Materno-Infantil Teresa Herrera, Hospital San Juan de la Cruz, Hospital Sant Joan de Déu Barcelona, Hospital Universitari Arnau de Vilanova, Hospital Universitari Joan XXIII de Tarragona, Hospital Universitario de Cabueñes, Hospital Universitario Infanta Leonor, Hospital Universitario Son Espases, Hospital Universitario Virgen de las Nieves, Hospital Universitario Vall Hebron, Hospital Jerez de la Frontera, Hospital La Fe Valencia, Hospital de Laredo, Hospital Príncipe de Asturias, Hospital Universitario de Basurto and Hospital Virgen de la Arrixaca in Murcia.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009600000001/v2_202201210729/S234128792100199X/v2_202201210729/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009600000001/v2_202201210729/S234128792100199X/v2_202201210729/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128792100199X?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 11 | 26 |
| 2024 October | 71 | 28 | 99 |
| 2024 September | 88 | 40 | 128 |
| 2024 August | 104 | 48 | 152 |
| 2024 July | 77 | 28 | 105 |
| 2024 June | 69 | 22 | 91 |
| 2024 May | 84 | 29 | 113 |
| 2024 April | 80 | 39 | 119 |
| 2024 March | 83 | 21 | 104 |
| 2024 February | 76 | 28 | 104 |
| 2024 January | 67 | 38 | 105 |
| 2023 December | 98 | 26 | 124 |
| 2023 November | 88 | 41 | 129 |
| 2023 October | 73 | 39 | 112 |
| 2023 September | 59 | 31 | 90 |
| 2023 August | 54 | 14 | 68 |
| 2023 July | 74 | 39 | 113 |
| 2023 June | 62 | 28 | 90 |
| 2023 May | 89 | 25 | 114 |
| 2023 April | 64 | 29 | 93 |
| 2023 March | 77 | 24 | 101 |
| 2023 February | 55 | 28 | 83 |
| 2023 January | 53 | 26 | 79 |
| 2022 December | 109 | 49 | 158 |
| 2022 November | 94 | 33 | 127 |
| 2022 October | 107 | 44 | 151 |
| 2022 September | 71 | 33 | 104 |
| 2022 August | 93 | 49 | 142 |
| 2022 July | 264 | 55 | 319 |
| 2022 June | 85 | 49 | 134 |
| 2022 May | 94 | 38 | 132 |
| 2022 April | 117 | 47 | 164 |
| 2022 March | 147 | 72 | 219 |
| 2022 February | 214 | 52 | 266 |
| 2022 January | 364 | 84 | 448 |
| 2021 December | 312 | 82 | 394 |
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