Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis

Matteo Puntoni^1*Caterina Caminiti^1*Giuseppe Maglietta¹Marcello Lanari²Giacomo Biasucci^3,4Agnese Suppiej⁵Federico Marchetti⁶Alessandro De Fanti⁷Fabio Caramelli²Lorenzo Iughetti⁸Chiara Ghizzi⁹Enrico Valletta¹⁰Gianluca Vergine¹¹Marcello Stella¹²Beatrice Rita Campana⁴Valentina Fainardi^13,4Michela Deolmi¹⁴Susanna Esposito^14,4

• ¹Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Emilia-Romagna, Italy
• ²Pediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
• ³Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
• ⁴Department of Medicine and Surgery, University of Parma, Parma, Emilia-Romagna, Italy
• ⁵Pediatric Clinic, University of Ferrara, Ferrara, Emilia-Romagna, Italy
• ⁶Pediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
• ⁷Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
• ⁸Department of Medical and Surgical, Maternal-Infantile and Adult Sciences, University of Modena and Reggio Emilia, Modena, Lombardy, Italy
• ⁹Paediatrics Unit, Maggiore Hospital, Bologna, Emilia-Romagna, Italy
• ¹⁰Pediatric Unit, G.B. Morgagni - L. Pierantoni Hospital, AUSL Romagna, Forlì, Italy
• ¹¹Pediatric Clinic, Rimini Hospital, AUSL Romagna, Rimini, Italy
• ¹²Pediatric Unit, AUSL Romagna, Cesena, Italy
• ¹³Pediatric Clinic, University Hospital of Parma, Parma, Italy
• ¹⁴Pediatric Clinic, University-Hospital of Parma,, Parma, Italy

Background Evidence exists on the major disruptions in pediatric healthcare services during the COVID-19 pandemic, but what happened when all restrictions were lifted is unclear. This study examined trends in pediatric hospital admission and Emergency Department visit rates during the first 12 months following the end of the state of emergency in Italy, compared to pre-pandemic levels. Methods We conducted a multicenter, retrospective, quasi-experimental before–after study including 11 North Italian hospitals. Using electronic health records from March 2017 to March 2023, we compared standardized rates recorded during 1 year after the end of the emergency with the pre-pandemic period, using interrupted time series. We examined trends overall and for diagnostic categories that had shown the largest impact in our previous studies covering data up to March 2022. Results A total of 104,083 hospitalizations and 858,762 Pediatric Emergency Department visits were analyzed. Compared to the three years before the outbreak, post-emergency hospitalization rates increased by 23% (Standardized Hospitalization Rate Ratio 1.23, 95% CI 1.20–1.25), whereas Pediatric Emergency Department visits, after a sharp decrease, returned to pre-pandemic rates (Standardized Incidence Rate Ratio 0.98, 95% CI 0.96–1.00). Mental health-related hospitalizations showed the largest increase, peaking in the first months of the post-pandemic year (level change, Hospitalization Rate Ratio (HRR) 2.57, 95% CI 1.61–4.12), then decreasing slightly but still remaining well above pre-pandemic values. Notably, hospitalization rates in adolescent girls (12–17 years) increased almost fourfold (level change, HRR 3.72, 95% CI 2.02–6.85, p<0.001), whereas the increase was not significant for boys (HRR 1.42, 95% CI 0.65–3.11, p=0.378). Respiratory diseases, after drastically declining during the pandemic, steadily increased and finally stabilized at pre-pandemic levels. Conclusion The COVID-19 pandemic has had long-term consequences on pediatric healthcare utilization. Data from this and future studies can inform proactive policies to mitigate disruptions and ensure access to essential pediatric services in future health crises. The persistent rise in hospital admissions for mental health disorders, especially among teenage girls, makes this a pressing public health priority.