\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{Paediatric Attendances and Acuity in the Emergency Department during the
COVID-19 Pandemic: A Comparative Analysis of Service Use}



\author[1]{Katy Rose}%
\author[1]{Kerry Van Zyl}%
\author[1]{Rachel Cotton}%
\author[2]{Susan Wallace}%
\author[1]{Francesca Cleugh}%
\affil[1]{Imperial College Healthcare NHS Trust}%
\affil[2]{Chelsea and Westminster Healthcare NHS Trust}%


\vspace{-1em}



  
  \date{June 18, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Aim: To investigate the difference in both numbers and acuity of
presentations to the Paediatric Emergency Department (PED) during the
peak time period of the current global SARS-CoV-2 pandemic. Design: This
single centre retrospective observational study used routinely collected
electronic health data to compare patient presentation characteristics
between 21st March and 26th April 2020 compared to the equivalent time
period in 2019. Results: There was a 90\% decrease in attendances to
PED, with a 10.23\% reduction re-attendance rate. Children presenting
were younger during the pandemic, with a median age difference of 2
years. They were more likely to present in an ambulance (9.63\%), be
admitted to hospital (5.75\%) and be assigned the highest two Manchester
triage categories (6.26\%). There was a non-significant trend towards
longer lengths of stay. The top 10 presenting complaints remained
constant (although the order changed) between time periods. There was no
difference in mortality or admission to PICU. Implications: Our data
demonstrates that there has been a significant decrease in numbers of
children seeking emergency department care. It suggests that presenting
patients were proportionally sicker during the pandemic; however, we
would argue that this is more in keeping with appropriate acuity for PED
presentations, as there were no differences in PICU admission rate or
mortality. We explore some of the possible reasons behind the decrease
in presentations and the implications for service planning ahead of the
winter months.%
\end{abstract}%



\sloppy


\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2/Figure-2}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

