The Impact of Strict Public Health Restrictions on Pediatric Critical Illness*

Abstract

OBJECTIVES: To characterize the impact of public health interventions on the volume and characteristics of admissions to the PICU. DESIGN: Multicenter retrospective cohort study. SETTING: Six U.S. referral PICUs during February 15, 2020–May 14, 2020, compared with the same months during 2017–2019 (baseline). Patients: PICU admissions excluding admissions for illnesses due to severe acute respiratory syndrome coronavirus 2 and readmissions during the same hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was admission volumes during the period of stay-at-home orders (March 15, 2020–May 14, 2020) compared with baseline. Secondary outcomes were hospitalization characteristics including advanced support (e.g., invasive mechanical ventilation), PICU and hospital lengths of stay, and mortality. We used generalized linear mixed modeling to compare patient and admission characteristics during the stay-at-home orders period to baseline. We evaluated 7,960 admissions including 1,327 during March 15, 2020–May 14, 2020. Daily admissions and patients days were lower during the period of stay-at-home orders compared with baseline: median admissions 21 (interquartile range, 17–25) versus 36 (interquartile range, 30–42) (p < 0.001) and median patient days 93.0 (interquartile range, 55.9–136.7) versus 143.6 (interquartile range, 108.5–189.2) (p < 0.001). Admissions during the period of stay-at-home orders were less common in young children and for respiratory and infectious illnesses and more common for poisonings, endocrinopathies and for children with race/ethnicity categorized as other/unspecified. There were no differences in hospitalization characteristics except fewer patients received noninvasive ventilation during the period of stay-at-home orders. CONCLUSIONS: Reductions in PICU admissions suggest that much of pediatric critical illness in younger children and for respiratory and infectious illnesses may be preventable through targeted public health strategies.

Consequences of Social Distancing Measures During the COVID-19 Pandemic First Wave on the Epidemiology of Children Admitted to Pediatric Emergency Departments and Pediatric Intensive Care Units: A Systematic Review

“…There was nearly a 50% decrease in general in the number of PICU admissions, and this can be important preliminary information for securing hospital beds in the event of a future pandemic or disaster, for instance, as a consequence of SDMs. These results have been confirmed by other studies published more recently (98)(99)(100).…”

Impact of the COVID-19 Pandemic on Diagnostic Frequency of Febrile Seizures: An Electronic Health Record Database Observational Study

“… 5 , 6 The same trend may be seen in pediatric populations including a decrease in viruses that are commonly associated with febrile seizures. 7 – 9 It is possible that the frequency of febrile seizures has also changed secondary to the mitigation strategies implemented during the COVID-19 pandemic.…”

Fundamentally Changing Pediatric Respiratory Illnesses…and Less “Bread and Butter”*

“…(3,1,8,9) We applaud the work of our colleagues who have asked a critical question , and even as intensivists consider a public health approach to decrease, if not eliminate childhood respiratory illnesses. (9) We reference our colleagues in the Pediatric Trauma Society who advocate for policies that minimize pediatric injuries, even as they care for children with injuries. (24) Might this be an example for public policy work, while we personally and institutionally work for change that will decrease pediatric respiratory illness overall?…”

“…(2,(6)(7)(8) Rather innovatively Maddux et al examined this period as a "natural experiment" for children's health. (9) Here they ask the question, is a substantial fraction of pediatric critical illness preventable? (9) They examine the volume and characteristics of admissions to six pediatric intensive care units as part of the "stay at home" orders, from 3/15/2020 to 5/14/2020, compared to the same period in years 2017, 2018, 2019 (baseline).…”

“…We (as parents, caregivers, members of society) owe much to our pediatric critical care colleagues who asked a non-COVID question in the midst of a COVID-19 pandemic, about our acceptances of "childhood illnesses" as problematic but not addressable (except through immunizations ). (1,3,8,9) However given what we now know, can we as a community "stay silent" and inactive? To address this will require some public health measures.…”