Preserving Margins to Promote Missions: COVID‐19's Toll on US Children's Hospitals

OBJECTIVES: Admissions to the ICU for children with hyperglycemic crisis (HGC, defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or hyperosmolar ketoacidosis) increased during the COVID-19 pandemic. We sought to identify if severity of illness for HGC also increased from prepandemic to pandemic years 1 and 2. METHODS: Retrospective study of children aged ≤18 years hospitalized in the Pediatric Health Information System for HGC. Pre-COVID-19 years were defined as March 2017–February 2020, COVID-19 year 1 as March 2020–February 2021, and COVID-19 year 2 as March 2021–February 2022. The primary outcome was ICU admission. Secondary outcomes included mortality, length of stay, cost, and use of neurologic therapies, mechanical ventilation, or vasoactive support. RESULTS: There were 46 425 HGC admissions to 42 hospitals, 20 045 (43.2%) of which were ICU admissions. In comparison with pre-COVID-19, children admitted in COVID-19 year 1 (odds ratio, 1.31 [95% confidence interval, 1.25–1.38], P < .0001) and year 2 (odds ratio, 1.17 [95% confidence interval, 1.11–1.22], P < .0001) had a higher odds of ICU admission in multivariable modeling after controlling for confounding variables. Severity of illness was higher during COVID-19 years when considering secondary outcomes, although these associations were not consistent across outcomes and year. There was no difference in mortality. CONCLUSIONS: Children with HGC had a higher severity of illness during the pandemic which was sustained over 2 years. Reduction in social distancing and evolving variants of SARS-CoV-2 over the 2 years of the pandemic did not significantly alter the relationship between HGC and higher requirement for ICU care.

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Association Between COVID-19 and Severity of Illness for Children With Hyperglycemic Crisis

Toomey

Klein

Vidmar

et al. 2023

Hospital Pediatrics

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Preserving Margins to Promote Missions: COVID‐19's Toll on US Children's Hospitals

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Association Between COVID-19 and Severity of Illness for Children With Hyperglycemic Crisis

Association Between COVID-19 and Severity of Illness for Children With Hyperglycemic Crisis

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