Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic

Abstract

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.

Keywords: COVID-19; epidemiology; pediatric critical care.

Figure 1

SMRs. Using PIM2 with 95% CIs, reference line at 1 indicates that the number of observed deaths is equal to the number of expected deaths. PIM2 = Pediatric Index of Mortality-2; Q1 = quartile 1; Q2 = quartile 2; SMR = standardized mortality ratios.

Figure 2

Diagnostic categories in Q1 and Q2 pre-COVID-19 (2017-2019) and during COVID-19 (2020). For each diagnosis, the bars represent the weighted annual average of the number of children admitted to a participating ICU. The diamond and whiskers represent the percentage of admissions due to each diagnosis, which were compared between pre-COVID-19 years and 2020 by using the χ² test with P values adjusted for multiple comparisons using the Bonferroni correction. Only diagnoses with ≥ 2,500 admissions in the entire dataset or statistically significant differences (Table 2) are shown. ICH = intracerebral hemorrhage; Q1 = quartile 1; Q2 = quartile 2; RACHS = risk adjustment for congenital heart surgery; URI = upper respiratory tract infection; VP = ventriculoperitoneal.