The Impact of COVID-19 on the Incidence of Pediatric Stridor in the Emergency Department

Introduction: Recent studies suggest COVID-19 may lead to upper airway obstruction, including croup. Recurrent croup is linked to later diagnoses of reactive airway disease (RAD) or asthma. This study evaluates the impact of the COVID-19 pandemic on the incidence of stridor in pediatric emergency departments and subsequent diagnoses of asthma/RAD.

Methods: This retrospective chart review of pediatric emergency visits at Jim Pattison Children’s Hospital analyzed data from March 2017 to March 2023. The pre-pandemic period was March 2017 to March 2020, and the pandemic period was March 2020 to March 2023. Incidence of stridor and related diagnoses were compared between the two periods. Data collected included age, sex, comorbidities, severity (work of breathing, Canadian Triage and Acuity Scale (CTAS)), COVID-19 status, previous croup, RAD/asthma diagnoses, admissions, and bronchodilator use. Chi-squared tests compared outcomes across the pre-pandemic and pandemic years 1, 2, and 3.

Results: The percentage of stridor-related ED visits was significantly decreased from 5.6% pre-pandemic to 2.0% (p < 0.001), 4.3%(p < 0.001), and 3.7% (p < 0.001) during years 1, 2, and delta wave (August 2021 to October 2021) of the pandemic. COVID-19-positive croup occurred only during the waves dominated by omicron variant including year 3. Stridor cases in pandemic years 1 and 2 were less severe, with significantly lower rates of work of breathing (WOB) (p < 0.001, p< 0.001) and bronchodilator use (p=0.005, p< 0.001). Year 3 only had greater rates of WOB (p < 0.001) but no significant change in bronchodilator use(p=0.075) in comparison to pre-pandemic era. Year 2 and 3 showed significantly lower rates of CTAS 1/2 scores(p=0.002, p< 0.001) and admissions(p=0.02, p=0.001). RAD/asthma diagnoses were significantly higher in all pandemic years compared to pre-pandemic eras. (year 1:p=0.009, year 2:p=0.037, year 3:p < 0.001)

Conclusions: The pandemic led to a decrease in stridor visits and severity, likely due to social distancing and masking. Patients during the pandemic were more likely to be diagnosed with RAD/asthma.