Pediatric Intensive Care Unit Admissions for COVID-19: Insights Using State-Level Data
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Rohit S Loomba1,2, Enrique G Villarreal3, Juan S Farias3
1Division of Pediatric Cardiac Critical Care, Advocate Children's Hospital, Chicago, IL, USA.
Insights
Pediatric COVID-19 admissions (CPAs) were analyzed, revealing low mortality (1.4%). Higher population density correlated with increased CPAs, while type 1 diabetes mellitus was linked to longer respiratory support needs.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare systems, particularly intensive care units.
- Pediatric intensive care unit (PICU) data regarding COVID-19 admissions is limited.
- Understanding factors influencing pediatric COVID-19 admissions is crucial for resource allocation and patient management.
Purpose of the Study:
- To characterize COVID-19 positive admissions (CPAs) in U.S. PICUs.
- To identify factors associated with CPA frequency and severity.
- To inform future research and clinical practice for pediatric COVID-19 patients.
Main Methods:
- Retrospective cohort study utilizing the COVID-19 Virtual Pediatric System (VPS) dashboard.
- Analysis of state-level data including population density, comorbidities, and social distancing scores.
- Univariate and multivariate regression analyses to assess associations between CPA frequency and admission outcomes.
Main Results:
- A total of 205 CPAs were reported across 48 states, with an estimated frequency of 2.8 per million children.
- Children over 11 years old and those with comorbidities (35.1%) were frequently admitted.
- Higher population density was associated with increased CPAs; pediatric type 1 diabetes mellitus correlated with longer mechanical ventilation and intubation durations.
Conclusions:
- Inpatient mortality for pediatric COVID-19 positive admissions in PICUs is low (1.4%).
- Population density appears to be a significant factor influencing CPA frequency.
- Type 1 diabetes mellitus is associated with increased need for advanced respiratory support and prolonged intubation in pediatric COVID-19 patients.
Introduction:
Intensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care units (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions.
Materials And Methods:
This is a retrospective cohort study using data from the COVID-19 Virtual Pediatric System (VPS) dashboard containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state-level data contained 13 different factors from population density, comorbid conditions, and social distancing score. The absolute CPA count was converted to frequency using the state's population. Univariate and multivariate regression analyses were performed to assess the association between CPA frequency and admission endpoints.
Results:
A total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPA frequency was 2.8 per million children in a one-month period. A total of 3,235 tests were conducted of which 6.3% were positive. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days (1.25-12.00 days). Out of the 1,132 total CPA days, 592 (52.2%) involved mechanical ventilation. The inpatient mortalities were 3 (1.4%). Multivariate analyses demonstrated an association between CPAs with greater population density (beta coefficient 0.01, p < 0.01). Multivariate analyses also demonstrated an association between pediatric type 1 diabetes mellitus with increased CPA duration requiring advanced respiratory support (beta coefficient 5.1, p < 0.01) and intubation (beta coefficient 4.6, p < 0.01).
Conclusions:
Inpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density. Type 1 DM appears to be associated with increased duration of HFNC and intubation. These factors should be included in future studies using patient-level data.
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