Early COVID-19 Pandemic Emergency Department Utilization for Pediatric Dental Emergencies

Abstract

Abstract Early COVID-19 Pandemic Emergency Department Utilization for Pediatric Dental Emergencies Daniel M. Walsh Co-chairs of the Supervisory Committee:Barbara Sheller, DDS, MSD Anne Reeves, DDS, MSD, MPH Bryan Williams, DDS, MSD, MEd Seattle Children’s Hospital Department of Pediatric Dentistry Research supported by the Dr. Bryan Williams Endowment for Pediatric Dental Medicine Seattle Children’s Hospital and Seattle Children’s Research Institute Research Integration Hub Core Services Research Support Fund Activity ID: CR00006192 Purpose: Early in the COVID-19 pandemic, government-imposed restrictions on dental practices from mid-March to mid-May 2020 effectively curtailed community practice. We analyzed utilization of a pediatric hospital emergency department (ED) for dental emergencies over the six months of maximal dental practice disruption, including dental office closures and reopening, compared to two previous years. Methods: Records of patients presenting to the ED were analyzed for: volume, presentation time, demographics, dental emergency type and acuity, and treatment(s) provided in the ED. Study patients presented 3/15-9/15/2020; control patients presented 3/15-9/15/2019 and 3/15-9/15/2018. Results: 138 study patients (mean age 6.4 years) and 171 controls (80 from 2018, 91 from 2019, mean age 7.0 years) were assessed. Emergency types were trauma 68%, caries 25%, and other 7% for both time periods (p=0.997). Increased ED resource use for study trauma patients included suturing (p=0.014), intravenous sedation (p=0.014), and medical radiology (p<0.001). Triage acuity ratings and presenting pain score for trauma patients did not differ: study 87.78% urgent and 72.83% no pain/mild pain versus control 92.31% urgent and 70.44 no pain/mild pain. Differences for study caries patients were: more presented during weekday business hours (p=0.039), more identified as persons of color (p=0.006), fewer saw their dentist prior to ED presentation (p=0.024), more received sedation (p=0.001), and more received definitive care in the ED (p=0.002). Triage acuity ratings and presenting pain score for caries patients were similar: study 85.29% urgent and 73.53% no pain/mild pain versus, controls 90.48% urgent and 60.97% no pain/mild pain. A non-significant decrease in opioids prescribed at discharge was observed for the study patients. Conclusions: Provision of care to patients with dental emergencies heightened utilization of ED resources early in the COVID-19 pandemic. Trauma patients consumed more ED services, reflecting both increased trauma severity and decreased use of the ED for minor trauma. Restricted community access to dental care disproportionally affected children of color with caries emergencies; ED presentation during weekday business hours suggests that their usual dental providers were unavailable.