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There has been justifiable concern about the impact of #COVID19, and particularly the lockdown, on children.
Our @LancetChildAdol paper evaluates delayed presentations to Emergency Departments (and it's not what you think)
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30206-6/fulltext
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Our @LancetChildAdol paper evaluates delayed presentations to Emergency Departments (and it's not what you think)
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30206-6/fulltext
/Thread
Early reports from Italy highlighted significant concern with children presenting late to hospital and coming to harm.
It's important to note in some of these cases advice not to present had come from previous contact with medical professionals
https://thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30108-5/fulltext
It's important to note in some of these cases advice not to present had come from previous contact with medical professionals
https://thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30108-5/fulltext
Anecodote and early reports in the UK supported this but it's important to recognise there is no definition of delayed presentation
There is no gold standard to suggest when a parent should bring a child to hospital
There is no gold standard to suggest when a parent should bring a child to hospital
Delayed presentations are not a new concept.
Children with newly diagnosed diabetes often present very unwell. This is because the changes happen gradually over time and parents don't notice.
Describing these as delayed during #COVID19 is event bias.
Children with newly diagnosed diabetes often present very unwell. This is because the changes happen gradually over time and parents don't notice.
Describing these as delayed during #COVID19 is event bias.
Previous studies have used 24 hours as a cut off but this has not been studied across a range of conditions
It is relevant to realise that outcomes of delayed presentions are not clear.
Serious case review and untoward incident investigations often demonstrate that illness is much easier to recognise retrospectively
Serious case review and untoward incident investigations often demonstrate that illness is much easier to recognise retrospectively
In our prospective surveillance study we asked asked clinicians to document
“Do the parents report delaying their attendance at ED for any reason?”
“Do the parents report delaying their attendance at ED for any reason?”
The reported delayed presentation rate was relatively low.
Of the 51 patients with a potential delay only six (11·8%) were admitted
Of the 51 patients with a potential delay only six (11·8%) were admitted
We are aware our study contrasts with an @ADC_BMJ paper in which 30% of paediatricians working in Emergency Departments had witnessed delayed presentations
This does not mean 30% of children had a delayed presentation & this was a retrospective study https://adc.bmj.com/content/early/2020/06/24/archdischild-2020-319848
This does not mean 30% of children had a delayed presentation & this was a retrospective study https://adc.bmj.com/content/early/2020/06/24/archdischild-2020-319848
Parents in particular should take confidence from our findings.
Clinicians reported red flag features in history & examination based on @RCPCHtweets guidance: https://issuu.com/joballrcpch/docs/covid19_advice_for_parents_when_child_unwell_or_in
This chart was distributed via a variety of channels during lockdown
Clinicians reported red flag features in history & examination based on @RCPCHtweets guidance: https://issuu.com/joballrcpch/docs/covid19_advice_for_parents_when_child_unwell_or_in
This chart was distributed via a variety of channels during lockdown
Red-flag symptoms were reported in 81 (6·0%) of 1349 patients.
Only two were felt to have been delayed in presenting and neither of these patients was admitted to hospital
It's reassuring that red flag features were not dismissed by parents
@ASKSNIFF @bestbeginnings
Only two were felt to have been delayed in presenting and neither of these patients was admitted to hospital
It's reassuring that red flag features were not dismissed by parents
@ASKSNIFF @bestbeginnings
Our study is not demonstrating that harm is not occuring to children - the impact on wider child health has been significant:
https://www.bmj.com/content/369/bmj.m2061
However the concern about lots of children staying away from acute and emergency care may have been overstated.
https://www.bmj.com/content/369/bmj.m2061
However the concern about lots of children staying away from acute and emergency care may have been overstated.
There is an important public health message for parents & carers on learning from normal trajectory of disease.
Many minor illnesses and injuries can be managed, safely, at home.
#COVID19 has provided an opportunity to teach parents about watchful waiting.
Many minor illnesses and injuries can be managed, safely, at home.
#COVID19 has provided an opportunity to teach parents about watchful waiting.
However if lockdown persists or has to be reinstated, then public health messages should reinforce the message that emergency services are open and accessible to children and young people. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30206-6/fulltext
Thanks to co-authors @RachelHarwood10, @DrDougalH, @doctorsanjay, @wheezylikesund1 and Nick Bishop
..and the sites (all part of @PERUKItweep) who helped with data collection
..and the sites (all part of @PERUKItweep) who helped with data collection
