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Inpatient Use and Outcomes at Children's Hospitals During the Early COVID-19 Pandemic
Jessica L Markham1,2, Troy Richardson3,4, Adrienne DePorre3,2
1Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; jlmarkham@cmh.edu.
Insights
The COVID-19 pandemic caused a 35% drop in pediatric hospitalizations, especially for respiratory illnesses like asthma and pneumonia. Hospital outcomes such as length of stay and mortality remained stable during this period.
Area of Science:
- Pediatric Health
- Epidemiology
- Health Services Research
Background:
- The COVID-19 pandemic significantly altered healthcare utilization patterns globally.
- Children's emergency department visits decreased, prompting an investigation into inpatient trends.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on inpatient utilization within children's hospitals.
- To compare inpatient use and clinical outcomes before and during the pandemic.
Main Methods:
- Retrospective study utilizing the Pediatric Health Information System (PHIS).
- Comparison of inpatient data from March 15 to August 29, 2020 (COVID-19 period) with the same period in the preceding three years (pre-COVID-19).
- Analysis using adjusted generalized linear mixed models for trends and outcomes across 15 All Patient Refined Diagnosis Related Groups (APR-DRGs).
Main Results:
- A total of 424,856 hospitalizations pre-COVID-19 and 91,532 during the COVID-19 period were analyzed.
- Overall hospitalizations declined by 35.1%, with significant reductions for asthma (81.3%), bronchiolitis (80.1%), and pneumonia (71.4%).
- Readmission rates decreased during the pandemic, while length of stay, cost, ICU use, and mortality remained largely consistent.
Conclusions:
- US children's hospitals experienced substantial decreases in inpatient admissions during the COVID-19 pandemic.
- Clinical outcomes at the hospital level remained largely unchanged, despite variations in utilization by condition.
- Respiratory conditions, including asthma, bronchiolitis, and pneumonia, saw the most significant declines in inpatient admissions.
Background And Objectives:
The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care use, including decreased emergency department visits for children. In this study, we sought to describe the impact of the COVID-19 pandemic on inpatient use within children's hospitals.
Methods:
We performed a retrospective study using the Pediatric Health Information System. We compared inpatient use and clinical outcomes for children 0 to 18 years of age during the COVID-19 period (March 15 to August 29, 2020) to the same time frame in the previous 3 years (pre-COVID-19 period). Adjusted generalized linear mixed models were used to examine the association of the pandemic period with inpatient use. We assessed trends overall and for a subgroup of 15 medical All Patient Refined Diagnosis Related Groups (APR-DRGs).
Results:
We identified 424 856 hospitalizations (mean: 141 619 hospitalizations per year) in the pre-COVID-19 period and 91 532 in the COVID-19 period. Compared with the median number of hospitalizations in the pre-COVID-19 period, we observed declines in hospitalizations overall (35.1%), and by APR-DRG (range: 8.5%-81.3%) with asthma (81.3%), bronchiolitis (80.1%), and pneumonia (71.4%) experiencing the greatest declines. Overall readmission rates were lower during the COVID-19 period; however, other outcomes, including length of stay, cost, ICU use, and mortality remained similar to the pre-COVID-19 period with some variability by APR-DRGs.
Conclusions:
US children's hospitals observed substantial reductions in inpatient admissions with largely unchanged hospital-level outcomes during the COVID-19 pandemic. Although the impact on use varied by condition, the most notable declines were related to inpatient admissions for respiratory conditions, including asthma, bronchiolitis, and pneumonia.
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