Inpatient Use and Outcomes at Children’s Hospitals During the Early COVID-19 Pandemic

Markham, Jessica L.; Richardson, Troy; DePorre, Adrienne G.; Teufel, Ronald J.; Hersh, Adam L.; Fleegler, Eric W.; Antiel, Ryan M.; Williams, Daniel C.; Goldin, Adam B.; Shah, Samir S.

doi:10.1542/peds.2020-044735

Cited by 31 publications

(33 citation statements)

References 24 publications

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“…To our knowledge, this is the first study to examine the long-term (one year since the lockdown started) impact of the COVID-19 pandemic on paediatric health service use for a wide range of health conditions at a large state-wide paediatric healthcare provider. Our findings converge with previous research showing rapidly reduced paediatric health service use following the implementation of the lockdown 1 , 3 , 29 and that the decline for most chronic conditions was only evident during the lockdown. After the lockdown, the service use generally returned to the pre-COVID predicted levels.…”

Section: Discussionsupporting

confidence: 91%

“…The immediate return to pre-COVID predicted levels for most chronic health conditions post-lockdown has highlighted the healthcare needs for children affected by chronic conditions. Similar to previous studies, the reduction in health service use was largely related to chronic respiratory conditions such as asthma 6 , 12 , 29 ; while, smaller reductions occurred in cancer and metabolic conditions 3 , . 6 , 29 The duration of decline in health service use related to chronic conditions was shorter in this study than that reported in the US where the reduction in health service use lingered for at least three months with extended pandemic 12 , .…”

Section: Discussionsupporting

confidence: 83%

“…Similar to previous studies, the reduction in health service use was largely related to chronic respiratory conditions such as asthma 6 , 12 , 29 ; while, smaller reductions occurred in cancer and metabolic conditions 3 , . 6 , 29 The duration of decline in health service use related to chronic conditions was shorter in this study than that reported in the US where the reduction in health service use lingered for at least three months with extended pandemic 12 , . 29 , 30 Further, the reduction during the lockdown was generally not translated into significantly excessive occasions of health service use for chronic conditions post-lockdown within the study period.…”

Section: Discussionsupporting

confidence: 83%

“… 6 , 29 The duration of decline in health service use related to chronic conditions was shorter in this study than that reported in the US where the reduction in health service use lingered for at least three months with extended pandemic 12 , . 29 , 30 Further, the reduction during the lockdown was generally not translated into significantly excessive occasions of health service use for chronic conditions post-lockdown within the study period. These findings may be attributable to the sharp and stringent social restriction measures implemented across Australia compared to most other nations when the pandemic emerged in early 2020.…”

Section: Discussioncontrasting

confidence: 51%

“…The persistently reduced health service use for acute infectious conditions is corroborated by previous research 5 , . 12 , 29 This reduction may be associated with the effects of social lockdown and good hygiene practice, suggesting that the risk of paediatric acute infections is modifiable by changes in health and social behaviours. 5 , 48 Further, our result of the increase in acute infections related hospital service use towards the end of year 2020 suggests a shifted season for acute infections, which has been evidenced in other Australian studies particularly on respiratory syncytial virus.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia – a time series analysis

Nassar

Shrapnel

et al. 2022

The Lancet Regional Health - Western Pacific

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia – a time series analysis

Nassar

Shrapnel

et al. 2022

The Lancet Regional Health - Western Pacific

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Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

Liang,

Wang,

Dahlen

et al. 2024

JAMA Netw Open

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IMPORTANCEUrinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes.OBJECTIVESTo examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity.DESIGN, SETTING, AND PARTICIPANTSThis retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021.EXPOSURETime periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021).MAIN OUTCOMES AND MEASURESThe primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis.RESULTSThe cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: −33.1% (95% CI, −39.4% to −26.1%) for all children and −52.1% (95% CI, −62.1% to −39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (−4.3%; 95% CI, −32.0% to 34.6% for all children) after the first 3 months of the pandemic.CONCLUSIONS AND RELEVANCEIn this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.

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Impact of the COVID‐19 pandemic on hospitalizations of children with neurologic impairment

Thomson

Richardson

Auger

et al. 2022

Journal of Hospital Medicine

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Introduction: Children with neurologic impairment (NI) are frequently hospitalized for infectious and noninfectious illnesses. The early period of the COVID-19 pandemic was associated with overall lower pediatric hospitalization rates, particularly for respiratory infections, but the effect on utilization for children with NI is unknown. Method: This multicenter retrospective cohort study included hospitalizations of children 1-18 years of age with NI diagnosis codes from 49 children's hospitals. We calculated the percent change in the median weekly hospitalization volumes and the hospitalization resource intensity score (H-RISK), comparing the early-COVID era (March 15, 2020 to December 31, 2020) with the pre-COVID era (same timeframe of 2017-2019). Percent change was calculated over the entire study period as well as within three seasonal time periods (spring, summer, and fall/winter). Differences between infectious and noninfectious admission diagnoses were also examined.Results: Compared with the pre-COVID era, there was a 14.4% decrease (interquartile range [IQR]: −33.8, −11.7) in the weekly median number of hospitalizations in the early-COVID era; the weekly median H-RISK score was 11.7% greater (IQR: 8.9, 14.9). Hospitalizations decreased for both noninfectious (−11.6%, IQR: −30.0, −8.0) and infectious (−35.5%, IQR: −51.1, −31.3) illnesses in the early-COVID era. This decrease was the largest in spring 2020 and continued throughout 2020.Conclusions: For children with NI, there was a substantial and significant decrease in hospitalizations for infectious and noninfectious diagnoses but an increase in illness severity during the early-COVID era compared with the pre-COVID era. Our data suggest a need to reconsider current thresholds for hospitalization and identify opportunities to support and guide families through certain illnesses without hospitalization.

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Inpatient Use and Outcomes at Children’s Hospitals During the Early COVID-19 Pandemic

Cited by 31 publications

References 24 publications

The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia – a time series analysis

The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia – a time series analysis

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

Impact of the COVID‐19 pandemic on hospitalizations of children with neurologic impairment

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