Delighted to report our paper examining the ‘missing’ children from hospitals during the first COVID-19 UK lockdown has just been published in @EurJPediatrics
rdcu.be/clnF6
Explanatory thread below:
rdcu.be/clnF6
Explanatory thread below:
1/ We were interested in discovering which children were ‘missing’ from hospital services as the first lockdown started. We analysed anonymised records of patients <16yrs in 2 Oxfordshire (UK) hospitals, providing secondary & tertiary care.
2/ We looked across 6 years: in 2020 prior to, during and after lockdown & 2015-2019 across matched dates including the same number of weekdays/weekends. ICD10 codes gave us the diagnoses of inpatients across all 6 years to assess ‘missing’ diagnoses during lockdown.
3/ Reductions in hospital attendance for children and adults were reported nationally & internationally. We corroborate this locally, demonstrating ED attendance down 57% / inpatient admissions down 59% during the first national lockdown (red), restrictions in yellow. 
4/ This was true across all paediatric age groups.
5/ There were fewer admissions from ED, but the same proportions of ED attendances were admitted and paediatric admissions had the same length of stay.
6/ However, we noticed that patients admitted during lockdown had more diagnoses, compared to previous years. We wondered if this was due to increased severity of illness, so used ICD10 diagnoses to dig deeper.
7/ Using ICD10 chapter headings (n=20 included), n=8 had significant reductions in weekly diagnoses in lockdown, whilst factors influencing health status and neoplasms were significantly increased.
8/ Factors influencing health status are typically secondary diagnoses which provide family or personal history of disease. We hypothesised that junior doctors had more time to document these during lockdown.
9/ Benign and malignant neoplasm diagnoses were both increased in lockdown (our figure below). An observation reported by Dopfer et al., in their analysis of ED admissions: doi.org/10.1186/s12887…
10/ Diagnoses which significantly increased/decreased during lockdown was categorised. 3 Groups which collectively had increased during lockdown were: Incidental findings/comorbidities, pandemic screening & other diagnoses.
11/ Other diagnoses included neoplasms, psychotherapy, hypertension & dietary counselling (Full list table 1). Incidental finding/co-morbidities include: allergy history, murmur unspecified, diabetes family history. Pandemic screening were observation/screening for disease.
12/ Pandemic screening & documenting co-morbidities explain increased diagnoses in lockdown, without increased disease severity. This is why we had a smaller reduction in lockdown diagnoses, compared to the reduction in admissions.
13/ Reduced diagnoses in lockdown fit 4 groups: Infective illnesses (46%), sequelae of infective illnesses (34%), non-specific aches/pains/malaise (11%), accidental injury/poisoning (9%).
14/ Infective disease accounts for 80% of ‘missing’ lockdown diagnoses. A testament to effective public health measures for COVID. Were parents/carers also more available to supervise mildly unwell children at home too? A breakdown of the diagnoses:
15/ Could some of those non-specific aches/pains/malaise or accidental injury/poisoning be missing safeguarding cases? This was the concern with school closures and a lack of service contact with children + pressures from families being locked down together.
16/ Some of the above may have been prevented/managed at home with parents working from home & locked down. Clearly closer supervision may have reduced accidental poisoning. Lockdown reduced specific injuries (no playgrounds open).
17/ In summary, we find the majority of children ‘missing’ during the first lockdown were secondary to massive reductions in infectious disease circulation. Schools & nurseries closed, social distancing, masks & handwashing.
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