BPSU 'snap-shot' survey - delayed presentations to hospitals

The COVID-19 pandemic led to concerns that children are, for various reasons, presenting late to emergency departments. This has led to delayed diagnosis and hence a delay in treatment. Such presentation delays are well known, but they appear to have increased during this pandemic. Unfortunately, there have been reports of increased morbidity and mortality as a result. This increase in delay may be due to the warnings with regards staying home and also nervousness on behalf of parents who may worry about their child catching COVID-19 whilst at hospital. This survey aimed to give a snap-shot of the frequency of such a delay.

Based on the results of the survey, a letter was published in Archives of Disease in Childhood - a link to which can be found below.

Lead investigators

Shamez Ladhani and Richard Lynn

British Paediatric Surveillance Unit
Royal College of Paediatrics and Child Health
5-11 Theobalds Road
London WC1X 8SH

Email: bpsu@rcpch.ac.uk / shamez.ladhani@phe.gov.uk

About the 'snap-shot' survey

The BPSU had received several queries from paediatricians who were concerned about late presentations of children because of lockdown and public messages to “stay at home”. To assess the extent of the problem, a one-off email was sent in April 2020 asking three questions:

  1. Are you working on the front line?
  2. Have you seen any children with delayed presentations?
  3. In your opinion, do you think they are COVID response related?

No details on individual children were collected.

The findings from the survey helped to raise awareness of the issue of delayed diagnosis and assess whether a more in-depth study was required to help address the issue. 


Based on the results of the survey, a letter was published in Archives of Disease in Childhood:

RM Lynn, JL Avis, S Lenton, Z Amin-Chowdhury, SN Ladhani. Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot survey of 4075 paediatricians in the UK and Ireland. Archives of Disease in Childhood. 2020 Jun 24.

Case definition

A broad definition of a "Late Presentation" is any child under the age of 16 years who presented later than you would have expected (resulting in more treatment or a worse outcome, or delayed presentation of a new condition such as ALL, diabetes mellitus, etc.) because of any number of reasons, including the "stay at home" message, parental concerns about seeking medical help or coming to hospital, etc.


The survey was a one-off and covered the last 14 days from 24 April 2020.

Two reminders were sent to maximise the return.