Pediatric Critical Illness in Wisconsin during the Epoch of COVID-19 in 2020

Abstract

Background We perceived profound changes in the frequency of and reasons for admissions to pediatric intensive care units (PICUs) during the advent of the COVID-19 pandemic in Wisconsin, and we hypothesized that the rates of total, scheduled, and respiratory viral admissions were lower during the first year of the pandemic than would have been predicted by historical admission data. We also hypothesized that the rates of other categories of PICU admissions were different than would have been predicted by historical data, reflecting broad changes in PICU utilization paradigms during the pandemic. Methods Using mean weekly admission rates with standard deviations and rate ratios with 95% confidence intervals, we compared all Wisconsin PICU admissions during the pandemic epoch in 2020 (COVID-2020) to admissions in seasonally-matched, growth-adjusted “no-COVID” forecasts generated by time series modeling from all Wisconsin PICU admissions in the previous 5 years. Results We studied 27,425 admissions with 294,577 associated diagnoses including 104 admissions associated with a COVID-19 diagnosis (4.3% of admissions in COVID-2020). Total admissions were 60 ± 9 week− 1 in COVID-2020 vs. 103 ± 4 forecasted, RR 0.63 (95% CI: 0.59–0.68), p < 0.001. Scheduled admissions were 17 ± 6 week− 1 in COVID-2020 vs. 28 ± 3 forecasted, RR 0.61 (95% CI: 0.55–0.67), p < 0.001. And respiratory viral admissions were 8 ± 5 week− 1 in COVID-2020 vs. 19 ± 9 forecasted, RR 0.40 (95% CI: 0.33–0.48), p < 0.001. Some admission categories experienced dramatic declines (e.g., respiratory/ENT) while others experienced less decline (e.g., injury/poisoning/adverse effects) or no significant change (e.g., diabetic ketoacidosis). While admission categories demonstrated variability in rate decline during COVID-2020, no category had significantly increased weekly admissions. Conclusions We quantify and describe the extent of PICU admission decline in the first year of COVID in Wisconsin, so informing health care staffing and service planning, decisions regarding pandemic mitigation, and other strategies to combat the evolving pandemic. Total, scheduled, and respiratory viral admissions declined by 37, 39, and 60%, respectively. About half the reduction in total admissions was from easily-predictable categories such as scheduled and respiratory viral admissions.