Table_8_Consequences of Social Distancing Measures During the COVID-19 Pandemic First Wave on the Epidemiology of Children Admitted to Pediatric Emergency Departments and Pediatric Intensive Care Units: A Systematic Review.DOCX

ObjectivesTo synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and pediatric intensive care units (PICU).
MethodsWe searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 including pre-print engines such as medRxiv, bioRxiv, Litcovid and SSRN for unpublished studies on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries, compared to the historical cohort in each studied region, country, or hospital.
ResultsWe identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. A significant decline was reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries.
ConclusionsSDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. However, some disease groups, such as burns and DKA, showed a tendency to increase and its severity of illness at hospital presentation. Continual effort and research into the subject should be essential for us to better understand the effects of this new phenomenon of SDMs to protect the well-being of children.
Systematic Review RegistrationClinicaltrials.gov, identifier: CRD42020221215.

研究目标：本系统评价旨在综合新冠疫情第一波期间社交距离措施（Social Distancing Measures, SDM）对儿童急性疾病影响的相关研究证据，重点关注儿科急诊科（Pediatric Emergency Departments, PED）与儿科重症监护室（Pediatric Intensive Care Units, PICU）的收治情况。
研究方法：本研究于2020年12月检索了多个数据库与文献资源，包括Cochrane系统评价数据库、Cochrane对照试验注册库、EPOC注册库、MEDLINE、循证医学评论数据库、EMBASE、世界卫生组织新冠数据库、Cochrane新冠资源库、牛津大学新冠证据服务平台、谷歌学术，同时检索medRxiv、bioRxiv、Litcovid、SSRN等预印本平台以获取未发表的新冠相关研究文献，未对研究设计进行筛选。本研究的主要结局指标为：相较于各研究区域、国家或医院的历史队列，儿科急诊科与儿科重症监护室收治病例的全球发病率、疾病病因，以及择期/急诊手术情况。
研究结果：本研究共检索到6660条文献记录，其中87篇文献符合纳入标准。所有纳入研究均采用与历史数据对比的前后研究设计，整体偏倚风险较高。纳入的39项研究显示，儿科急诊科每日收治量的中位数降至基线水平的65%；8项研究显示儿科重症监护室收治量较基线降低54%。另有5项研究报告急性呼吸道疾病与下呼吸道感染（Lower Respiratory Tract Infection, LRTI）的发病率显著下降，中位数降幅达63%。未观察到中毒发病率存在一致变化趋势，但烧伤、糖尿病酮症酸中毒（Diabetic Ketoacidosis, DKA）的发病率呈上升趋势，创伤与非计划手术的发病率则呈下降趋势。
研究结论：新冠疫情第一波期间实施的社交距离措施，降低了儿童急性疾病的全球发病率。但部分疾病群体，如烧伤与糖尿病酮症酸中毒，其发病率及患者就诊时的疾病严重程度呈上升趋势。未来仍需持续开展相关研究与探索，以更好地明晰社交距离措施这一新型公共卫生干预手段的影响，从而切实保护儿童的健康福祉。
系统评价注册信息：Clinicaltrials.gov，注册号：CRD42020221215。