Unveiling the Mystery of ‘Missing’ Pediatric Patients During the COVID-19 Lockdown

Hello there, clinical coding enthusiasts! Today we’re going on an intriguing journey into the curious case of ‘missing’ diagnoses amongst paediatric admissions during the UK’s first national lockdown. Researchers James E G Charlesworth, Rhian Bold, and Rani Pal have been scrutinizing the ICD-10 diagnostic codes in a bid to crack this puzzle. Let’s dive in.

Context – When the World Locked Down

When COVID-19 hit us, public health measures radically transformed every aspect of our lives, including healthcare accessibility and utilization. Pediatric health services were no exception. Anecdotal evidence suggests that during national and regional lockdowns, pediatric Emergency Department (ED) attendances and inpatient admissions plummeted worldwide.

##The Study – Finding the Missing Patients##

The research team set out to retrospectively examine children (0-15 years) seeking urgent care across Oxfordshire during the first UK lockdown in 2020. They compared these findings with matched dates from the previous five years (2015-2019) across two pediatric hospitals.

Crunching the Numbers

When the numbers rolled in, the results were quite astounding. Total ED attendances and hospital admissions during the first UK lockdown had shrunk by 56.8% and 59.4% respectively, compared to the previous five years. However, the proportions of patients admitted from the ED and the length of stay remained similar across 2015-2020.

The Missing Diagnoses

Looking closely at the ICD-10 diagnoses during the lockdown, an interesting pattern emerged. The diagnoses of neoplasms (tumors) significantly increased. But there were ‘missing’ diagnoses too – a whopping 80% of them were categorized as infectious diseases or their sequelae, while 20% were non-specific pains/aches/malaise and accidental injury/poisonings.

So, Where Did They Go?

This decrease in certain diagnoses may be due to a mix of factors. The stringent public health infection control measures likely succeeded in reducing disease transmission. Parents and carers may have chosen to manage mild or self-limiting diseases at home. Lastly, pandemic-related healthcare anxieties might have also discouraged people from seeking medical help.

Next Steps

In the wake of these findings, it’s vital to ensure that referral pathways are fine-tuned to identify vulnerable children and those with social concerns, to avoid delayed presentation. Future prospective studies should focus on this aspect.


As we navigate through the COVID-19 era, it’s essential to understand the pandemic’s impact on healthcare utilization and adapt accordingly. The case of ‘missing’ pediatric patients highlights the need for robust healthcare systems that can weather crises without losing sight of vulnerable populations.

That’s it for today’s deep dive, health mavens! Remember, the health of our children is the health of our future. Until next time, stay safe, informed, and proactive!


Charlesworth JEG, Bold R, Pal R. Using ICD-10 diagnostic codes to identify ‘missing’ paediatric patients during nationwide COVID-19 lockdown in Oxfordshire, UK. Eur J Pediatr. 2021 Nov;180(11):3343-3357. doi: 10.1007/s00431-021-04123-x. Epub 2021 May 26. PMID: 34037838; PMCID: PMC8150620.

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