Results
A total of 512 children presented to the ED for asthma related symptoms
during the study periods: 273 children during 2019 (124 in 2019A, 89 in
2019B and 60 in 2019C) and 239 children during 2020 (125 in 2020A, 51 in
2020B and 63 in 2020C). Demographic data were similar except for their
age, which was younger during 2019; median age of 5.2, 5.3 and 4.7 years
during 2019A, 2019B and 2019C compared with 6.7, 6.7 and 6.6 years
during 2020A, 2020B and 2020C, respectively (p=0.06). Male and Bedouin
Arab descent were the majority of the study population in all periods.
There were more visits among Bedouin patients during lockdown, compared
with the parallel period in 2019 (60.7 % in 2019B vs 78.4 in 2020B,
p=0.002). Similar number of patients with chronic non-respiratory
diseases (e.g. epilepsy, Down syndrome) and chronic respiratory diseases
(bronchopulmonary dysplasia, pulmonary hypertension and obstructive
sleep apnea) or atopy was observed during 6 time periods. Data regarding
the use of chronic respiratory medications; inhaled corticosteroids
(ICS), long acting beta agonist (LABA), short acting beta agonists
(SABA) and leukotriene receptor antagonist (LTRA) is presented intable 1 .
We identified a decrease in use of chronic respiratory treatment in 2020
compared with 2019; 17.7%, 11.2% and 20% during 2019 A, 2019B and
2019C in comparison to 11.2%, 5.9% and 6.3% during 2020A, 2020B and
2020C respectively (p= 0.013). Mean vital signs (fever, blood pressure
and oxygen saturation on room air) were similar between time periods,
except for heart rate (124 vs 115 beats per minute, p=0.039) and
respiratory rate (30 vs 25 breaths per minute, p=0.005) that were lower
during 2020, compared with 2019. Similar rate of abnormal radiological
findings included bilateral hyperinflation, lobar infiltrates and
atelectasis was observed (Table 2 ). Treatment during ED visit
included oxygen, inhaled beta agonist and anticholinergic agents,
systemic steroids, inhaled steroids, antihistamines and antibiotics
(Table 3 ). Treatments were similar between periods except for
sodium chloride 0.9% for inhalation, which significantly decreased
during 2020 compared with 2019 (19.6% vs 48.3 %, p=0.002).
There was no difference in the triage acuity evaluation on admission to
the ED. We report a significantly fewer ED visits during the lockdown
period, comparing to the parallel period in 2019. A clear trend was
demonstrated during 2019 with fewer visits, as time goes by, in the
spring and summer time. On the contrary, during 2020 we demonstrated
similar visits’ numbers prior to lockdown (124 vs 125 visits), with
significant decrement during lockdown (89 vs 51 visits) and increment
post lockdown (60 vs 63 visits). When standardized for number of visits
per day, as the duration of each time period was different (A- 6 weeks,
B- 8 weeks and C- 6 weeks), similar results were observed. Number of ED
visits per day was 3.3, 1.8 and 1.7 during 2019A, 2019B and 2019C
respectively, in comparison to 3.1, 1.4 and 2 during 2020A, 2020B and
2020C respectively (p <0.001), Figure 1a .
The number of visits per day increased significantly in the era after
lockdown when comparing 2020C to 2020B (2 vs. 1.43 visits per day,
p<0.001) as well as when compared to the same time period in
2019 (2 vs 1.76 visits per day (p<0.001) (Table 3 ).
During lockdown, hospitalization rate was higher (47.1% vs 33.7%,
p=0.05) as was length of stay (3.15 vs 1.9 days, p= 0.03), possibly
indicating higher severity (Figure 1b ). Only 6 patients were
admitted or transferred to the PICU during 6 time periods, 4 of them
necessitated high flow nasal cannula ventilation. There was no
difference in PICU admissions rate or LOS in PICU, between time periods.