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Reduction in paediatric intensive care admissions during COVID-19 lockdown in Maryland, USA.

ABSTRACT: As a public health measure during the COVID-19 pandemic, governments around the world instituted a variety of interventions to 'flatten the curve'. The government of Maryland instituted similar measures. We observed a striking decline in paediatric intensive care unit (PICU) admissions during that period, mostly due to a decease in respiratory infections. We believe this decline is multifactorial: less person-to-person contact, better air quality and perhaps 'fear' of going to a hospital during the pandemic. We report an analysis of our PICU admissions during the lockdown period and compared them with the same time period during the four previous years.

SUBMITTER: Graciano AL

PROVIDER: S-EPMC7640529 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Reduction in paediatric intensive care admissions during COVID-19 lockdown in Maryland, USA.

Graciano Ana Lia AL Bhutta Adnan T AT Custer Jason W JW

BMJ paediatrics open 20201103 1

As a public health measure during the COVID-19 pandemic, governments around the world instituted a variety of interventions to 'flatten the curve'. The government of Maryland instituted similar measures. We observed a striking decline in paediatric intensive care unit (PICU) admissions during that period, mostly due to a decease in respiratory infections. We believe this decline is multifactorial: less person-to-person contact, better air quality and perhaps 'fear' of going to a hospital during ...[more]

PMID: 33173836

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Project description:During the COVID-19 pandemic, lockdown posed a number of unprecedented problems. Accidents to children are a major public health concern. This study sought to determine the impact of France's 2020 COVID-19 lockdown on hospital admissions for paediatric accidents. This study was a retrospective cohort analysis of data from the French national inpatient database. Children admitted to a French hospital for an accident from January to July 2020 and 2019 were included. The number of admissions for accidents between January and July in 2020 (the study period) vs. the same period (the control period) in 2019 was recorded. Hospital admission rate ratios (HRRs) comparing 2020 with 2019 were calculated for three periods in 2020 and 2019: before lockdown (P1, January 1 to March 15), during lockdown (P2, March 16 to May 10), and after lockdown (P3, May 11 to July 31). A total of 72,089 children were admitted to hospital for accidents between January and July 2020 (mean (SD) age, 8.7 (5.8)), and 84,961 between January and July 2019 (mean (SD) age, 9.2 (5.7)). A total of 12,864 children (18%) were admitted during the lockdown period (P2) in 2020, and 23,098 (27%) during the equivalent period in 2019 (HRR, 0.56; 95% confidence interval (CI), 0.55-0.57; p < .001). There were significantly fewer admissions for accidents in 2020 than in 2019; the HRR was 0.97 (95% CI, 0.96-0.99; p = .003) for P1 and 0.95 (95% CI, 0.93-0.96; p < .001) for P3. During the 2020 lockdown period (P2), the risk of accident-related paediatric admissions with critical care lasting for at least 1 day was lower than in 2019 (HRR 0.67; 95% CI, 0.62-0.73; p < .001).ConclusionsFurther research could usefully examine how parents create a safe home environment for their children.What is known• During the COVID-19 pandemic, lockdown posed a number of unprecedented problems. Accidents to children are a major public health concern. This study sought to determine the impact of France's 2020 COVID-19 lockdown on hospital admissions for paediatric accidents.What is new• The first nationwide COVID-19 lockdown in France was associated with a decrease in the absolute number of hospital admissions for paediatric accidents, for all age groups, as well as the number of accident-related paediatric hospital stays involving critical care.

Project description:IntroductionIntensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care units (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions.Materials and methodsThis is a retrospective cohort study using data from the COVID-19 Virtual Pediatric System (VPS) dashboard containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state-level data contained 13 different factors from population density, comorbid conditions, and social distancing score. The absolute CPA count was converted to frequency using the state's population. Univariate and multivariate regression analyses were performed to assess the association between CPA frequency and admission endpoints.ResultsA total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPA frequency was 2.8 per million children in a one-month period. A total of 3,235 tests were conducted of which 6.3% were positive. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days (1.25-12.00 days). Out of the 1,132 total CPA days, 592 (52.2%) involved mechanical ventilation. The inpatient mortalities were 3 (1.4%). Multivariate analyses demonstrated an association between CPAs with greater population density (beta coefficient 0.01, p < 0.01). Multivariate analyses also demonstrated an association between pediatric type 1 diabetes mellitus with increased CPA duration requiring advanced respiratory support (beta coefficient 5.1, p < 0.01) and intubation (beta coefficient 4.6, p < 0.01).ConclusionsInpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density. Type 1 DM appears to be associated with increased duration of HFNC and intubation. These factors should be included in future studies using patient-level data.

Project description:Background: After the COVID-19 pandemic reached France in January 2020, a national lockdown including school closures was officially imposed from March 17, 2020, to May 10, 2020. Pediatric intensive care units (PICUs) admit critically ill infants, children and teenagers with severe acute conditions, in particular infectious and traumatic diseases. We hypothesized that PICU admissions would be considerably modified by the lockdown. Aims: The objectives of the study were to describe the type of admissions to French PICUs and to compare the occupation of PICU beds according to local epidemic conditions during the French national lockdown period, compared with the same period the previous year. Methods: We conducted a retrospective multicenter study in 14 French PICUs. All children aged from 7 days to 18 years admitted to one of the 14 participating PICUs over two 3-month period (March 1, 2020, to May 31, 2020 and March 1, 2019, to May 31, 2019) were included. Analysis was based on data extracted from the medicalized information systems program (a national database used in all French hospitals, into which all admissions and their diagnoses are coded for the purpose of calculating hospital funding). Each main diagnosis was reclassified in 13 categories, corresponding to normal PICU admissions. Results: We analyzed a total of 3,040 admissions, 1,323 during the 2020 study period and 1,717 during the same period in 2019. Total admissions decreased by 23% [incidence rate ratio (IRR) 0.77, 95% CI 0.71-0.83, p < 0.001], in particular for viral respiratory infections (-36%, IRR 0.64, 95% CI 0.44-0.94, p = 0.001). Admissions for almost all other diagnostic categories decreased, except intoxications and diabetes which increased, while admissions for cardiac and hemodynamic disorders were stable. Patient age and the sex ratio did not differ between the two periods. Median length of stay in the PICU was longer in 2020 [4 (IQR 2-9) vs. 3 (IQR 1-8) days, p = 0.002] in 2019. Mortality remained stable. Conclusions: In this large national study, we showed a decrease in the number of PICU admissions. The most severe patients were still admitted to intensive care and overall mortality remained stable.

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Reduction in paediatric intensive care admissions during COVID-19 lockdown in Maryland, USA.

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Reduction in paediatric intensive care admissions during COVID-19 lockdown in Maryland, USA.

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