Changes in Pediatric Intensive Care Unit Utilization and Clinical Trends during the Coronavirus Pandemic

Zee-Cheng, Janine; McCluskey, Casey K.; Klein, Margaret J.; Scanlon, Matthew C.; Rotta, Alexandre T.; Shein, Steven L.; Pineda, Jose A.; Remy, Kenneth E.; Carroll, Christopher L.

Background Children have been less impacted by the Coronavirus disease 19 (COVID) pandemic, but its repercussions on pediatric illnesses may have been significant. We examined 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 2nd quarter of 2020, and were there significant changes in the types of diseases admitted? Study Design and Methods Retrospective observational cohort study using the Virtual Pediatric Systems (VPS, LLC) database. Participants were 160,295 children admitted to the Pediatric Intensive Care Unit (PICU) at 77 sites in the United States during quarters 1 (Q1) and 2 (Q2) of 2017-2019 (pre-COVID) and 2020 (COVID). Results The average number of admissions was similar between pre-COVID Q1 and COVID Q1, but decreased by 32% from pre-COVID Q2 to COVID Q2 (20,157 to 13,627 admissions/quarter). The largest decreases were in respiratory conditions, including asthma (1,327 subjects in pre-COVID Q2 [6.6% of patients] vs 241 subjects in COVID Q2 [1.8%]; p<0.001) and bronchiolitis (1,299 [6.5%] vs 121 [0.9%]; p<0.001). The percentage of trauma admissions increased, though 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 Q2 increased compared to pre-COVID Q2 [OR 1.165; 95% CI 1.00, 1.357; p=0.049]. Interpretation Pediatric critical illness admissions decreased substantially during the 2nd 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.