title: The impact of SARS on a tertiary care pediatric emergency department.
abstract: BACKGROUND
  The Greater Toronto Area (GTA) was considered a "hot zone" for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital.
  
  
  METHODS
  We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000-2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest.
  
  
  RESULTS
  Compared with the 2000-2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (p < 0.001) and increases in admission rates (p < 0.001) during the periods in 2003 when there were new and active cases of SARS in the GTA. All 3 outcomes returned to expected estimates coincident with the absence of SARS cases from September to December 2003.
  
  
  CONCLUSIONS
  During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.
authors.affiliation: Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ont. boutis@sympatico.ca
authors.forename: Kathy
authors.initials: K
authors.lastname: Boutis
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Kelvin
authors.initials: K
authors.lastname: Lam
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
mesh_terms: D002170:Canada / Q000453:epidemiology; D002675:Child, Preschool; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics; D012189:Retrospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology*