Pediatric tertiary emergency care departments in Zagreb, Rijeka, and Split before and during the coronavirus disease 2019 pandemic: a Croatian national multicenter study

Aim To assess the number of visits to pediatric emergen - cy departments in Croatia and reasons for visiting before and during the coronavirus disease 2019 (COVID-19) pan - demic. Methods We reviewed the medical records of pediatric patients visiting emergency departments of four tertiary medical centers between February 25 and April 25, 2018 and 2019, and between February 25 and April 24, 2020. An - timicrobial prescription was analyzed as well. Results There were altogether 46 544 visits – 18218 in 2018, 19699 in 2019, and 8634 in 2020. The overall num - ber of visits in 2020 significantly decreased compared with 2018 and 2019 (52% and 56% reduction, respectively), mostly due to a decreased number of visits due to certain infectious diseases: acute gastroenteritis (89.2%), sepsis/ bacteremia (81.2%), urinary tract infections (55.3%), and lower respiratory tract infections (58%). Most visits were self-referrals regardless of the analyzed period, and the ma - jority of patients did not require hospitalization. There were no significant differences in the number of visits requiring urgent medical care, such as those due to seizures and ur - gent surgery. The most frequently prescribed antibiotic in all periods was amoxicillin, followed by amoxicillin/clavu - lanate and oral cephalosporins. Conclusion A significant reduction in the number of pe - diatric emergency department visits and hospital admis - sions is indirectly related to the COVID-19 pandemic. Most of the reduction was due to a decreased number of infec - tious disease cases. However, the number of visits requir - ing urgent medical intervention did not change.