The COVID-19 infection was initially identified in Wuhan, China in December 2019, with cases of pneumonia of unknown origin.1 The first reported cases of COVID-19 in the UK were identified at the end of January 2020.2 The WHO declared the COVID-19 pandemic on 11 March 2020.1 COVID-19 gives rise to respiratory symptoms accompanied by other syndromic features, with older individuals disproportionately affected.3 The UK government introduced social distancing and national lockdown measures from March 2020 (box 1).4

First COVID-19 case in UK: 29 January 2020.

COVID-19 pandemic declared by The WHO: 11 March 2020.

First national lockdown: 26 March–15 June 2020.*

Online school learning: from 24 March with phased reopening from 1 June 2020.

School summer holiday: 23 July–1 September 2020.

Return to in-school learning for all students: 3 September–18 December 2020.

Second national lockdown (continuation of normal schooling): 5 November–2 December 2020.*

Christmas school holiday: 19 December 2020–3 January 2021

Third national lockdown: 6 January 2021–11 April 2021.*

Restart of online school learning: 6 January 2021–7 March 2021.

The impact COVID-19 has on older members of society is well documented.3 Children, adolescents and young adults however are largely not particularly unwell with COVID-19.5 There are potential indirect impacts of the pandemic on children with possible social, economic, psychological and medical affects. Adolescents and young adults are another vulnerable group, especially in terms of mental health problems.6 The Office for National Statistics has documented a general rise in symptoms of depression.7 Parents have had to make the decision as to whether their child sufficiently unwell to need to be taken to hospital during the pandemic. Barriers to presentation to hospital may include societal restrictions, problems with local transport and illness and shielding in the family. A decrease in paediatric emergency presentations was seen in the few months following the onset of the pandemic in March 2020 in different UK hospitals.8 9 This decrease in paediatric emergency presentations and healthcare utilisation is potentially harmful, especially with serious medical and surgical pathologies.10 11

In this study, we explored the impact of COVID-19 on emergency presentations in 0–24 year olds over the first year of the pandemic in a large emergency department (ED) and regional mixed major trauma centre. The two key objectives were first to assess the impact on overall ED presentations and hospital admissions and second to assess the impact of the pandemic on a number of specific medical, surgical, trauma and mental health conditions.