• James E G Charlesworth, Rhian Bold, and Rani Pal.
• Oxford University Hospitals NHS Foundation Trust (John Radcliffe and Horton Hospitals), Oxfordshire, UK. James.charlesworth@doctors.org.uk.
• Eur. J. Pediatr. 2021 May 26.

AbstractThe study aims to identify 'missing' diagnoses amongst paediatric admissions during the UK's first national lockdown, compared with the previous 5 years. A retrospective observational cohort study of all children (0-15 years) attending for urgent care across Oxfordshire, during the first UK lockdown in 2020, compared to matched dates in 2015-2019, across two paediatric hospitals providing secondary care, including one with tertiary services. Our outcome measures were changes in numbers of patients attending and inpatient diagnoses (using ICD-10 classification) during the first 2020 lockdown, compared with the previous 5 years, were used. We found that total Emergency Department (ED) attendances (n = 4030) and hospital admissions (n = 1416) during the first UK lockdown were reduced by 56.8% and 59.4%, respectively, compared to 2015-2019 (5-year means n = 7446.8 and n = 2491.6, respectively). Proportions of patients admitted from ED and length of stay were similar across 2015-2020. ICD-10 diagnoses in lockdown of 2020 (n = 2843) versus matched 2015-2019 dates (n = 19,946) demonstrated significantly greater neoplasm diagnoses (p = 0.0123). Of diagnoses 'missing' in lockdown, 80% were categorised as infectious diseases or their sequelae and 20% were non-specific pains/aches/malaise and accidental injury/poisonings.Conclusions: Pandemic public health measures significantly altered paediatric presentations. Oxfordshire hospitals had a 58% reduction in ED attendances/inpatient admissions, with 'missing' diagnoses predominantly infection-related illnesses. These are likely driven by a combination of the following: (1) public health infection control measures successfully reducing disease transmission, (2) parents/carers keeping mild/self-limiting disease at home, and (3) pandemic-related healthcare anxieties. Prospective studies are needed to ensure referral pathways identify vulnerable children, those with social concerns, and avoid delayed presentation. What is Known: • Significant reductions of paediatric ED attendances and inpatient admissions are reported globally, throughout national and regional lockdowns for COVID-19. • Previous studies (supplemental table 5) examined only ED diagnoses or specific inpatient diagnoses during lockdown periods, demonstrating reductions of infectious diseases, accidents/injuries, and safeguarding referrals. What is New: • Using ICD-10 coding, robustly controlling for five historical years and adopting a hypothesis-independent analysis, demonstrating 80% of 'missing' inpatient diagnoses during national COVID-19 lockdown were infectious diseases or its sequelae, the remainder being non-specific aches/pains/malaise and accidental injuries/poisonings. • Greater numbers of neoplasms and other specific diagnoses were detected during lockdown, including greater documentation of co-morbidities and incidental findings.

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