Pediatric ICU admissions significantly decreased during COVID-19 pandemic

In the U.S., pediatric ICU admissions showed significant changes in diseases seen in patients and a substantial decrease during the COVID-19 pandemic, according to findings published in Chest.

“Severe infections, traumatic injuries, perioperative conditions and acute exacerbations of chronic illnesses such as asthma and diabetes are among the most common causes of admission to a pediatric ICU; thus, the epidemiology of pediatric critical illness was likely sensitive to the indirect effects of COVID-19,” Janine E. Zee-Cheng, MD, adjunct clinical assistant professor of pediatrics in the department of pediatrics at Indiana University School of Medicine, Indianapolis, and colleagues wrote.

Using the Virtual Pediatric Systems database, this retrospective observational cohort study included 160,295 children who were admitted to a pediatric ICU at 77 U.S. sites during the pre-COVID-19 first and second quarters of 2017 and 2019 and the first and second quarters of 2020 during the pandemic.

Average pediatric ICU admissions were similar in the first quarter of 2017 and 2019 before the COVID-19 pandemic and in the first quarter of 2020 during the pandemic (23,197 vs. 22,895 admissions per quarter, respectively). There was a 32% decrease in pediatric ICU admissions from the second quarter of pre-COVID-19 years to the second quarter of 2020 during the pandemic (20,157 vs. 13,627 admissions per quarter).

In the second quarter of 2017 and 2019 and the second quarter of 2020, asthma (1,327 vs. 241 patients) and bronchiolitis (1,299 vs. 121 patients) demonstrated the largest decreases in pediatric ICU admissions (P < .001). From the second quarter of 2017 and 2019 and the second quarter of 2020, researchers observed an increase in children requiring intubation (4,191 vs. 4,739), diabetes admissions (1,033 vs. 1,276) and poisoning/ingestion admissions (856 vs. 946); however, the raw number of children requiring intubation decreased (4,191 vs. 2,920).

Compared with the second quarter of 2017 and 2019, illness severity-adjusted odds for ICU mortality for patients in the pediatric ICU increased during second quarter of 2020 in the multivariable model (OR = 1.17; 95% CI, 1-1.36; P = .047).

“The disproportionate impact on specific conditions provides unique insight on the causative factors underlying pediatric critical illness and should be further investigated,” the researchers wrote. “Pending external validation, the observed increase in mortality risk warrants consideration to avoid indirect harms to children from this pandemic that predominantly affects adults.”