Intended for healthcare professionals


Covid-19: Delays in attending emergency departments may have contributed to deaths of nine children

BMJ 2020; 369 doi: (Published 30 June 2020) Cite this as: BMJ 2020;369:m2624

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  1. Jacqui Wise
  1. London

Delays in going to the emergency department because of the coronavirus pandemic lockdown may have been a contributory factor in the deaths of nine children, a snapshot survey of consultant paediatricians in the UK and Ireland has shown.

Three of the reported deaths associated with delayed presentation were due to sepsis, three were due to a new diagnosis of malignancy, in two the cause was not reported, and one was a new diagnosis of metabolic disease.

The British Paediatric Surveillance Unit carried out an electronic survey on 24 April of 4075 paediatric consultants, representing over 90% of all of those working in the UK and Ireland. They were asked whether, during the previous 14 days, they had seen any children who had presented later than they would have expected before the covid-19 pandemic.

Over the next seven days 2433 (60%) paediatricians responded, showed findings published in the Archives of Disease in Childhood.1 Overall, 241 (32%) of 752 paediatricians working in emergency departments and paediatric assessment units had witnessed delayed presentations: 57 (8%) respondents reported three or more patients with delayed presentation.

Public health messaging

New diagnoses of diabetes mellitus or diabetic ketoacidosis were the most common delayed presentations, but sepsis and malignancy were also reported. Delayed presentation reports ranged from 14% in Wales to 47% in the Midlands.

Of the paediatricians working on hospital wards and in clinics, 18% (178 of 997) had also witnessed delayed presentations. Neonatologists were concerned about late presentations during labour that resulted in adverse maternal or neonatal outcomes and early hospital discharges after birth, before feeding had been established, that resulted in infants then returning to hospital with feeding difficulties and severe dehydration.

Community paediatricians expressed concerns about the fall in referrals for child protection, and oncologists were worried about the fall in referrals for suspected cancer.

The study authors acknowledged that the information collected in the survey was subjective and based on the opinion of individual paediatricians, with no baseline data for comparison. However, they said that the findings highlighted an urgent need to improve public health messaging for parents, which until recently had instructed everyone to stay at home.

Russell Viner, president of the Royal College of Paediatrics and Child Health, which co-owns the Archives of Disease in Childhood with BMJ, said, “One of the few consistent points of good news is that children are unlikely to become unwell, even if exposed to the virus. The impact for children is what we call ‘collateral damage,’ including long absences from school and delays or interruptions to vital services. We know that parents adhered very strongly to the ‘stay at home advice,’ and we need to say clearly that this doesn’t apply if your child is very sick.”

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