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Lehan E, Briand P, O’Brien E, Hafeez AA, Mulder DJ. Synergistic patient factors are driving recent increased pediatric urgent care demand. PLOS DIGITAL HEALTH 2024; 3:e0000572. [PMID: 39172742 PMCID: PMC11340883 DOI: 10.1371/journal.pdig.0000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/04/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES We aimed to use the high fidelity urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. METHODS The dataset for this retrospective cohort study was obtained from our local healthcare centre's national reporting data for pediatric urgent care visits from 2006 to 2022. Variables analyzed included: basic patient demographics, chief complaint, triage urgency, date and time of registration/discharge, discharge diagnosis, and discharge destination. Statistical analysis of non-linear trends was summarized by locally estimated scatterplot smoothing splines. For machine learning, we used the tidymodels R package. Models were validated in training using k-fold cross validation with k = 5. We used univariate linear regression as a baseline model. After the data was standardized, correlation and homoscedasticity were evaluated between all parameter permutations. RESULTS This dataset consisted of 164,660 unique visits to our academic centre's pediatric urgent care. Over the study period, there was an overall substantial increase in the number of urgent care visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The increased length of stay trend was consistent across presenting complaint categories. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed the relative importance of features to predicting a visit in 2022 were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age. CONCLUSIONS This study identified a combination of declining primary care access, circulating viral infections, and shifting chief complaints as factors driving the recent increase in frequency and duration of visits to our urgent care service.
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Affiliation(s)
- Emily Lehan
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
| | - Peyton Briand
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Department of Medicine, Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada
| | - Eileen O’Brien
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Department of Medicine, Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada
| | | | - Daniel J. Mulder
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Department of Medicine, Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada
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Strum RP, McLeod B, Mondoux S, Miller P, Costa AP. Post-Pandemic Growth in 9-1-1 Paramedic Calls and Emergency Department Transports Surpasses Pre-Pandemic Rates in the COVID-19 Era: Implications for Paramedic Resource Planning. PREHOSP EMERG CARE 2024:1-8. [PMID: 38990606 DOI: 10.1080/10903127.2024.2372452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES The COVID-19 pandemic led to a decline in emergency department (ED) visits and a subsequent return to baseline pre-pandemic levels. It is unclear if this trend extended to paramedic services and if patient cohorts accessing paramedics changed. We examined trends and associations between paramedic utilization (9-1-1 calls and ED transports) and the COVID-19 timeframe. METHODS We conducted a retrospective cross-sectional study using paramedic call data from the Hamilton Paramedic Services from January 2016 to December 2023. We included all 9-1-1 calls where paramedics responded to an incident, excluding paramedic interfacility transfers. We calculated lines of best fit for the pre-pandemic period (January 2016 to January 2020) and compared their predictions to the actual volumes in the post-pandemic period (May 2021 to December 2023). We used an interrupted time series regression model to determine the association between pandemic timeframes (pre-, during-, post-COVID-19) and paramedic utilization (9-1-1 calls and ED transports), while testing for annual seasonality. RESULTS During the study timeframe, 577,278 calls for paramedics were received and 413,491 (71.6%) were transported to the ED. Post-pandemic, 9-1-1 calls exceeded predicted pre-pandemic levels by 1,298 per month, while ED transports exceeded by 543 per month. The pandemic significantly reduced monthly 9-1-1 calls (-588.2, 95% CI -928.8 to -247.5) and ED transports (-677.3, 95% CI -927.0 to -427.5). Post-pandemic, there was a significant and sustained resurgence in monthly 9-1-1 calls (1,208.0, 95% CI 822.1 to 1,593.9) and ED transports (868.8, 95% CI 585.8 to 1,151.7). Both models exhibited seasonal variations. CONCLUSIONS Post-pandemic, 9-1-1-initiated paramedic calls experienced a substantial increase, surpassing pre-pandemic growth rates. ED transports returned to pre-pandemic levels but with a steeper and continuous pattern of growth. The resurgence in paramedic 9-1-1 calls and ED transports post-COVID-19 emphasizes an urgent necessity to expedite development of new care models that address how paramedics respond to 9-1-1 calls and transport to overcrowded EDs.
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Affiliation(s)
- Ryan P Strum
- Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Brent McLeod
- Hamilton Paramedic Services, Hamilton, Ontario, Canada
| | - Shawn Mondoux
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Emergency Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Paul Miller
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Wilton J, Abdulmenan J, Chong M, Becerra A, Najmul Hussain M, Harrigan SP, Velásquez García HA, Naveed Z, Sbihi H, Smolina K, Taylor M, Adhikari B, Zandy M, Setayeshgar S, Li J, Abdia Y, Binka M, Rasali D, Rose C, Coss M, Flatt A, Mussavi Rizi SA, Janjua NZ. Cohort profile: the British Columbia COVID-19 Cohort (BCC19C)-a dynamic, linked population-based cohort. Front Public Health 2024; 12:1248905. [PMID: 38450137 PMCID: PMC10914982 DOI: 10.3389/fpubh.2024.1248905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose The British Columbia COVID-19 Cohort (BCC19C) was developed from an innovative, dynamic surveillance platform and is accessed/analyzed through a cloud-based environment. The platform integrates recently developed provincial COVID-19 datasets (refreshed daily) with existing administrative holdings and provincial registries (refreshed weekly/monthly). The platform/cohort were established to inform the COVID-19 response in near "real-time" and to answer more in-depth epidemiologic questions. Participants The surveillance platform facilitates the creation of large, up-to-date analytic cohorts of people accessing COVID-19 related services and their linked medical histories. The program of work focused on creating/analyzing these cohorts is referred to as the BCC19C. The administrative/registry datasets integrated within the platform are not specific to COVID-19 and allow for selection of "control" individuals who have not accessed COVID-19 services. Findings to date The platform has vastly broadened the range of COVID-19 analyses possible, and outputs from BCC19C analyses have been used to create dashboards, support routine reporting and contribute to the peer-reviewed literature. Published manuscripts (total of 15 as of July, 2023) have appeared in high-profile publications, generated significant media attention and informed policy and programming. In this paper, we conducted an analysis to identify sociodemographic and health characteristics associated with receiving SARS-CoV-2 laboratory testing, testing positive, and being fully vaccinated. Other published analyses have compared the relative clinical severity of different variants of concern; quantified the high "real-world" effectiveness of vaccines in addition to the higher risk of myocarditis among younger males following a 2nd dose of an mRNA vaccine; developed and validated an algorithm for identifying long-COVID patients in administrative data; identified a higher rate of diabetes and healthcare utilization among people with long-COVID; and measured the impact of the pandemic on mental health, among other analyses. Future plans While the global COVID-19 health emergency has ended, our program of work remains robust. We plan to integrate additional datasets into the surveillance platform to further improve and expand covariate measurement and scope of analyses. Our analyses continue to focus on retrospective studies of various aspects of the COVID-19 pandemic, as well as prospective assessment of post-acute COVID-19 conditions and other impacts of the pandemic.
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Affiliation(s)
- James Wilton
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Jalud Abdulmenan
- Data Analytics, Reporting, and Evaluation, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Mei Chong
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- Trauma Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Ana Becerra
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
| | - Mehazabeen Najmul Hussain
- Data Analytics, Reporting, and Evaluation, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Sean P. Harrigan
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Héctor Alexander Velásquez García
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Zaeema Naveed
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hind Sbihi
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kate Smolina
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Marsha Taylor
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Binay Adhikari
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Moe Zandy
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
| | - Solmaz Setayeshgar
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Julia Li
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Younathan Abdia
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mawuena Binka
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Drona Rasali
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Caren Rose
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Coss
- Data Analytics, Reporting, and Evaluation, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - Seyed Ali Mussavi Rizi
- Data Analytics, Reporting, and Evaluation, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Naveed Zafar Janjua
- BC Center for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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Lu VM, Niazi TN. Epidemiology of pediatric sports-related concussions presenting to the emergency room over the last decade in the United States. Clin Neurol Neurosurg 2023; 235:108023. [PMID: 37924720 DOI: 10.1016/j.clineuro.2023.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND There continues to be clinical significance of pediatric sports-related concussion (pSRC) for pediatric specialists. The overall trends of pSRC are not well understood. The aim of this study was to summarize the epidemiology of pSRC presenting to the emergency room (ER) in the United States (US) over the last decade. METHODS The National Electronic Injury Surveillance System (NEISS) database was retrospectively interrogated to identify pediatric (≤ 18 years) presenting to ERs in the US between 2013 and 2022. Weighted estimates and 95 % confidence intervals (CI) were generated using survey data analyses, and trends evaluated using linear regression analyses. RESULTS In 2022, an estimated total of 96,135 [95 % CI 71,486-120,783] cases of pSRC presented to the ER, equivalent to 132 [97-165] cases per 100,000 pediatric population. There has been a significant downtrend in pSRC presentations over the last decade (P = 0.02), with 2020 having the lowest number of cases in the 2013-2022 time period. In terms of gender, the latest proportion of presentations were 65 % [63-67 %] male and 35 % [33-37 %] female, with there being a significantly higher proportion of females and lower proportion of males over the last decade (P < 0.01). Of all causes for pSRC, the most frequent by proportion were football in 23 % [20-26 %], soccer in 9.6 % [7.7-12 %], basketball in 8.6 % [7.0-10 %], bicycle in 5.0 % [4.0-6.3 %], and baseball 4.1 % [3.3-5.0 %], with both football and basketball rates decreasing over the last decade. In 2020, there was a noticeable, non-sustained, decrease in proportion of football and basketball presentations, and an increase in proportion of bicycle presentations. Finally, there were multiples differences between sports and gender with only four in common sports causes amongst the ten most common sports (football, basketball, soccer, bicycle), although they were differently ranked by gender. CONCLUSIONS In the last decade, the incidence of pSRC presenting to the ER in the US has decreased. This is likely driven by decrease in proportion of football and basketball related injuries, which in turn has led to an increase in proportion of female pSRC which more commonly result from other sports. The Covid-19 pandemic in 2020 resulted in a number of trend anomalies which have since largely resolved. This data implicates that future prevention and treatment protocols should be more individualized.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, United States; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Toba N Niazi
- Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, United States; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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