Abstracts

Rationale:
COVID-19 is a global public health crisis and has great impact in health care system. Reports have shown that utilization of acute medical services have been affected by the COVID-19 pandemic. Strict infection control measures have been implemented. Fear about nosocomial infection or avoidance of overloading the health care system may be prohibitive for medical consultation. We aimed at investigating any change in Emergency Department (A&E) visits due to seizures in pediatric population. We then try to postulate explanations behind.
Method:
  A territory-wide retrospective observation study was conducted in Hong Kong. It involved public hospital system which provides more than 90% of acute medical service locally. Eligible patients were of age below 18 years with a diagnosis of seizure who presented to the A&E. Study period was from January 23, 2020 (when first local COVID-19 was confirmed) to April 22, 2020 which was compared to parallel control periods from 2015 to 2019. A&E visits for upper respiratory tract infections (URTIs) and all causes in the study and control periods were also compared. Patient disposition outcomes including length of hospital stay, ICU admission rate, mortality rate and early A&E re-attendance rate (within 28 days) were also studied. Subgroups of young children (aged 0-6 year) and old children (aged 7-18 year) were further analyzed. The subgroup definition was of clinical relevance as febrile seizures were major seizure disorder in young children. URTIs were studied as respiratory viral infections are a main trigger for febrile seizures in young children.  
Results:
A total of 148 seizure-related A&E visits after the local outbreak of COVID-19 was recorded. There was a 70% drop when compared with the average number in the control periods. Such a drop was proportionate to the drop in total A&E visits in the same period, which also showed a 70% reduction compared to the control periods. In subgroup analysis, the drop was even greater in the young children group, which was 78% while the drop in older children group was 46%. A great of drop of 86% in A&E visits for URTIs was also observed in young children after the outbreak. The patient disposition outcomes were similar between the study period and the average in control periods.  
Conclusion:
  There was a significant drop in A&E visits for seizures during the COVID-19 pandemic in pediatric population in Hong Kong. The drop was more drastic in younger children. The plausible explanations included change in medical help-seeking behavior and reduction in URTIs leading to a fall in febrile seizure incidence.
Funding:
:No funding is involved.