TY - JOUR
T1 - Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic
AU - Zee-Cheng, Janine E.
AU - McCluskey, Casey K.
AU - Klein, Margaret J.
AU - Scanlon, Matthew C.
AU - Rotta, Alexandre T.
AU - Shein, Steven L.
AU - Pineda, Jose A.
AU - Remy, Kenneth E.
AU - Carroll, Christopher L.
N1 - Funding Information:
Author contributions: J. E. Z.-C. is the guarantor for the content of the manuscript, including the data and analysis. All authors conceptualized and designed the study. J. Z.-C. C. L. C. and C. K. M. wrote the initial manuscript, edited and reviewed subsequent manuscript drafts, and prepared the manuscript for publication; M. J. K. performed all formal data analysis and created tables and figures, and edited and reviewed manuscript drafts; M. C. S. performed project administration, assisted with methodology, and edited and reviewed manuscript drafts; A. T. R. performed project administration, assisted with methodology, and edited and reviewed manuscript drafts; S. L. S. curated and maintained data, developed initial methodology, and edited and reviewed manuscript drafts; K. E. R. performed project administration, assisted with methodology, and edited and reviewed manuscript drafts; J. A. P. maintained data, assisted with methodology and data analysis, and edited and reviewed manuscript drafts. Financial/nonfinancial disclosures: None declared. Other contributions: The authors greatly acknowledge the work of Nicholas Huff, MD, in helping to develop the methodology used to simplify the STAR code diagnoses. Additional information: The xge-Appendix and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Publisher Copyright:
© 2021 American College of Chest Physicians
PY - 2021/8
Y1 - 2021/8
N2 - Background: Children have been less affected by the COVID-19 pandemic, but its repercussions on pediatric illnesses may have been significant. This study examines the indirect impact of the pandemic on a population of critically ill children in the United States. Research Question: Were there significantly fewer critically ill children admitted to PICUs during the second quarter of 2020, and were there significant changes in the types of diseases admitted? Study Design and Methods: This retrospective observational cohort study used the Virtual Pediatric Systems database. Participants were 160,295 children admitted to the PICU at 77 sites in the United States during quarters 1 (Q1) and 2 (Q2) of 2017 to 2019 (pre-COVID-19) and 2020 (COVID-19). Results: The average number of admissions was similar between pre-COVID-19 Q1 and COVID-19 Q1 but decreased by 32% from pre-COVID-19 Q2 to COVID-19 Q2 (20,157 to 13,627 admissions per quarter). The largest decreases were in respiratory conditions, including asthma (1,327 subjects in pre-COVID-19 Q2 (6.6% of patients) vs 241 subjects in COVID-19 Q2 (1.8%; P < .001) and bronchiolitis (1,299 [6.5%] vs 121 [0.9%]; P < .001). The percentage of trauma admissions increased, although the raw number of trauma admissions decreased. Admissions for diabetes mellitus and poisoning/ingestion also increased. In the multivariable model, illness severity-adjusted odds of ICU mortality for PICU patients during COVID-19 Q2 increased compared with pre-COVID-19 Q2 (OR, 1.165; 95% CI, 1.00-1.357; P = .049). Interpretation: Pediatric critical illness admissions decreased substantially during the second quarter of 2020, with significant changes in the types of diseases seen in PICUs in the United States. There was an increase in mortality in children admitted to the PICU during this period.
AB - Background: Children have been less affected by the COVID-19 pandemic, but its repercussions on pediatric illnesses may have been significant. This study examines the indirect impact of the pandemic on a population of critically ill children in the United States. Research Question: Were there significantly fewer critically ill children admitted to PICUs during the second quarter of 2020, and were there significant changes in the types of diseases admitted? Study Design and Methods: This retrospective observational cohort study used the Virtual Pediatric Systems database. Participants were 160,295 children admitted to the PICU at 77 sites in the United States during quarters 1 (Q1) and 2 (Q2) of 2017 to 2019 (pre-COVID-19) and 2020 (COVID-19). Results: The average number of admissions was similar between pre-COVID-19 Q1 and COVID-19 Q1 but decreased by 32% from pre-COVID-19 Q2 to COVID-19 Q2 (20,157 to 13,627 admissions per quarter). The largest decreases were in respiratory conditions, including asthma (1,327 subjects in pre-COVID-19 Q2 (6.6% of patients) vs 241 subjects in COVID-19 Q2 (1.8%; P < .001) and bronchiolitis (1,299 [6.5%] vs 121 [0.9%]; P < .001). The percentage of trauma admissions increased, although the raw number of trauma admissions decreased. Admissions for diabetes mellitus and poisoning/ingestion also increased. In the multivariable model, illness severity-adjusted odds of ICU mortality for PICU patients during COVID-19 Q2 increased compared with pre-COVID-19 Q2 (OR, 1.165; 95% CI, 1.00-1.357; P = .049). Interpretation: Pediatric critical illness admissions decreased substantially during the second quarter of 2020, with significant changes in the types of diseases seen in PICUs in the United States. There was an increase in mortality in children admitted to the PICU during this period.
KW - COVID-19
KW - epidemiology
KW - pediatric critical care
UR - http://www.scopus.com/inward/record.url?scp=85108084439&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2021.03.004
DO - 10.1016/j.chest.2021.03.004
M3 - Article
C2 - 33727033
AN - SCOPUS:85108084439
VL - 160
SP - 529
EP - 537
JO - Chest
JF - Chest
SN - 0012-3692
IS - 2
ER -