Extreme heat and risk of pediatric emergency department visits: a time-stratified time-series analysis

Kurzfassung

Background Children are vulnerable to heat, yet evidence on heat-related pediatric emergency department (ED) use in Germany remains limited. We quantified the acute short-term effects of extreme heat exposure on ED visits among children aged 0-18 years in Baden-Württemberg, Germany.

Methodology We assessed short-term effects of extreme heat on ED visits among children aged 0-18 years, including perinatal conditions in infants born at or after 22 weeks´ gestation, in Baden-Württemberg, Germany using 2.83 million records from (2014-2022). A time-stratified quasi-Poisson design with distributed lag non-linear model (lag 0-5 days) was applied, adjusting for air quality, spatiotemporal factors, and COVID-19 hospitalizations.

Results Higher temperatures increased ED visits risk, strongest within 0-2 days. Cumulative relative risks increased by 4.2% (95% CI 3.7-4.8), 7.1% (6.1-8.1), and 9.6% (8.2-11.1) at the 95th, 99th, and 99.9th temperature percentiles, respectively. Heat-sensitive diagnoses included heat-related illnesses (+63%, 51-76), perinatal conditions (+57%, 26-92), and otitis media and externa (+25%, 16-33). Children < 5 years had higher ED visit rates share on hot days (RR 1.036, 1.02-1.05).

Conclusion Heat exposure increases pediatric ED use, highlighting the need of child-specific thresholds and targeted preparedness strategies.