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The Impact of Strict Public Health Restrictions on Pediatric Critical Illness
Aline B Maddux1,2, Kristen Campbell1, Alan G Woodruff3
1Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Insights
Public health interventions significantly reduced pediatric intensive care unit (PICU) admissions, particularly for respiratory and infectious illnesses in young children. These findings highlight the potential for public health strategies to prevent critical pediatric illnesses.
Area of Science:
- Pediatric critical care medicine
- Public health policy
- Epidemiology
Background:
- Public health interventions, such as stay-at-home orders, were implemented globally in response to the COVID-19 pandemic.
- The impact of these interventions on pediatric critical care admissions was not well characterized.
Purpose of the Study:
- To analyze the effect of public health interventions on the volume and characteristics of pediatric intensive care unit (PICU) admissions.
- To compare PICU admissions during stay-at-home orders with pre-pandemic baseline data.
Main Methods:
- A multicenter retrospective cohort study was conducted across six U.S. referral PICUs.
- Data from February 15, 2020, to May 14, 2020, were compared to the same period in 2017-2019.
- Generalized linear mixed modeling was used to compare patient and admission characteristics.
Main Results:
- A significant reduction in daily PICU admissions and patient days was observed during the stay-at-home order period compared to baseline (p < 0.001).
- Admissions were less common for young children and for respiratory and infectious illnesses, but more common for poisonings and endocrinopathies.
- No significant differences were found in hospitalization characteristics, except for a decrease in noninvasive ventilation use.
Conclusions:
- The observed reductions in PICU admissions suggest that many cases of pediatric critical illness, especially in younger children and those with respiratory or infectious conditions, may be preventable.
- Targeted public health strategies could play a crucial role in reducing the burden of pediatric critical illness.
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.
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