In this study, we investigated the effect and impact of COVID-19 on the flow pattern of ED visits related to the pediatric population and presenting with a neurological complaint. Many studies were conducted to assess the change in the flow pattern and hospitalization [13,14,15,16]. However, these studies addressed the general pediatric population, primarily focusing on respiratory-related patients. Nonetheless, studies addressing the effect of the pandemic on pediatric neurology admissions do exist but address other aspects, including the utilization of telemedicine during the pandemic era [17, 18]. Furthermore, in our local literature, no studies have measured the effect of the pandemic on pediatric neurology cases despite the high volume of admissions, making this article and its data of important necessity. In this study, in which 960 visits were analyzed, we found that 309 visits were recorded during the pre-COVID-19 era, while 651 cases were recorded during COVID-19. In comparison, other studies had an average of 823 visits during the pre-COVID-19 era and 339 visits during the COVID-19 era [15]. Moreover, Gavish et al. recorded 587, 638, and 258 visits during the years 2018, 2019, and 2020, respectively [14]. The mean age of patients in our study was 5.29 ± 4.19 years, suggesting that the majority of patients present at a very early age. This echoes the findings of Devrim et al., who found a mean age of 4 years among some pediatric groups. [19] The highest number of visits according to age group was among school-age patients (n = 279) in comparison to the higher number of visits among adolescents in the literature [13].

There were no significant differences according to the patients' gender (P-value = 0.212), which was similar to the literature findings [15]. However, this was not the case regarding the LOS, in which our study presented statistical significance (P-value = 0.000) compared to other studies [15]. Other studies which investigated specific pediatric groups showed significant changes in the LOS of their patients (P < 0.001). [13] Also, the LOS in hours decreased by 47.0% during the pandemic, as the median duration for the length of stay in our study was 16.48 ± 33.53 in the pre-pandemic period and 7.76 ± 7.27 during the pandemic. This can be attributed to the measures taken against the COVID-19 disease during the pandemic and people being protective, resulting in reduced hospital presentations and admissions.

However, in literature studies, variability in the LOS was observed. During COVID-19, an increase in the LOS was seen in resuscitation areas in contrast to emergency neurology areas, which showed less change prior to and during the pandemic [20].

Moreover, seizures were a leading complaint in our cohort. Despite this, other studies had fever as a leading complaint and seizures presenting in a fraction of the cases [21]. In the context of the whole pediatric population, it was estimated that nearly one-fourth will present with neurological, psychiatric, and developmental diseases [16]. According to our findings, the top 10 complaints presenting to the ED remained essentially the same across both periods, with seizures remaining the leading cause of visits before and during the pandemic with 33% and 10.63%, respectively, followed by post-ictal, which accounts for the second most complaints before and during the pandemic with percentages of 15.5% and 21.4%, respectively.

During and prior to the pandemic, diagnoses of seizure or epilepsy were observed in nearly half of the visits. This came in line with the literature, which previously highlighted an increase in the risk, in pediatric patients in particular, of developing seizures after acquiring the COVID-19 infection [22].

Furthermore, the length of stay in hours decreased by 47.0% during the pandemic, as the median duration for the length of stay in our study was 16.48 ± 33.53 in the pre-pandemic period and 7.76 ± 7.27 during the pandemic. This can be attributed to the measures taken against the COVID-19 disease during the pandemic and people being protective, resulting in reduced hospital presentations and admissions.