Examining Pediatric Emergency Utilization Trends Before and After the COVID-19 Pandemic: An Eight-Year Cohort Study from a South Korean Tertiary Center

<b>Purpose:</b> This study investigates trends in pediatric emergency department (ED) utilization before and after the COVID-19 pandemic, with a focus on age-specific patterns, triage severity, diagnostic categories, and clinical presentations. <b>Methods:</b> Data were collected for 71,560 individuals (40,428 males and 31,132 females aged 0-18 years) who visited the ED at Samsung Changwon Hospital between 1 January 2016 and 31 December 2023. Patients were categorized into pre-COVID-19 (2016-2019) and post-COVID-19 (2020-2023) periods. Age, Korean Triage and Acuity Scale (KTAS) scores, visit outcomes, diagnostic codes (ICD-10), and vital signs were analyzed. Age-specific analyses were performed in four groups: <12 months, 1-6 years, 7-12 years, and 13-18 years. <b>Results:</b> Since the COVID-19 pandemic, pediatric ED visits have decreased by 55.5%. The proportion of visits by infants (<12 months) and young children (1-6 years) decreased, and adolescent visits increased. Post-pandemic, there was a significant increase in lower-acuity visits (KTAS 4) and discharge rates, alongside a reduction in admissions. Visits for respiratory and infectious diseases (ICD-10 J and A & B codes) decreased markedly, and visits for non-specific symptoms (R codes) and trauma (S & T codes) increased. The mean body weight of young children increased significantly after the COVID-19 period. <b>Conclusions:</b> The COVID-19 pandemic has had a profound and lasting effect on pediatric emergency department utilization, with changes in the number of visits, illness patterns, and severity by age group. These findings highlight the need for age-specific strategies in emergency planning and pediatric public health policy, particularly in managing the indirect effects of pandemic-induced changes in behavior and access to healthcare.