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Impact of COVID-19 on Admissions and Outcomes for Children With Complex Chronic Conditions
Jessica L Markham1,2, Troy Richardson1,3, Ronald J Teufel4
1aChildren's Mercy Kansas City and the University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Insights
Pediatric complex chronic conditions (CCCs) inpatient admissions dropped nearly 20% during the COVID-19 pandemic, with significant declines for respiratory illnesses but an increase for diabetes. Hospital outcomes remained stable.
Area of Science:
- Pediatric healthcare utilization
- Epidemiology of chronic conditions
- Public health during pandemics
Background:
- Pediatric health care use decreased during the COVID-19 pandemic.
- The impact on children with complex chronic conditions (CCCs) is not well-documented.
Purpose of the Study:
- To analyze the pandemic's effect on inpatient admissions and outcomes for children with CCCs.
- To compare pediatric CCC inpatient trends during the COVID-19 pandemic versus pre-pandemic periods.
Main Methods:
- Multicenter cross-sectional study using Pediatric Health Information System data.
- Examined admissions from January 2020 to March 2021, comparing to the prior 3 years.
- Utilized generalized linear mixed models to assess pandemic period associations with outcomes.
Main Results:
- Overall admissions for children with CCCs declined by 19.5% during the COVID-19 pandemic.
- Significant admission decreases were observed for pneumonia and bronchiolitis (49.7%-57.7%), while diabetes admissions increased by 21.2%.
- Length of stay, costs, and ICU use showed statistically higher rates during the pandemic but were similar overall to pre-pandemic levels.
Conclusions:
- Total admissions for children with CCCs decreased by nearly 20% during the pandemic.
- Respiratory illnesses saw the most substantial declines in admissions among prevalent conditions.
- Despite admission fluctuations, overall hospital-level outcomes for these children remained consistent.
Background:
Although pediatric health care use declined during the coronavirus disease 2019 (COVID-19) pandemic, the impact on children with complex chronic conditions (CCCs) has not been well reported.
Objective:
To describe the impact of the pandemic on inpatient use and outcomes for children with CCCs.
Methods:
This multicenter cross-sectional study used data from the Pediatric Health Information System. We examined trends in admissions between January 2020 through March 2021, comparing them to the same timeframe in the previous 3 years (pre-COVID-19). We used generalized linear mixed models to examine the association of the COVID-19 period and outcomes for children with CCCs presenting between March 16, 2020 to March 15, 2021 (COVID-19 period) to the same timeframe in the previous 3 years (pre-COVID-19).
Results:
Children with CCCs experienced a 19.5% overall decline in admissions during the COVID-19 pandemic. Declines began in the second week of March of 2020, reaching a nadir in early April 2020. Changes in admissions varied over time and by admission indication. Children with CCCs hospitalized for pneumonia and bronchiolitis experienced overall declines in admissions of 49.7% to 57.7%, whereas children with CCCs hospitalized for diabetes experienced overall increases in admissions of 21.2%. Total and index length of stay, costs, and ICU use, although statistically higher during the COVID-19 period, were similar overall to the pre-COVID-19 period.
Conclusions:
Total admissions for children with CCCs declined nearly 20% during the pandemic. Among prevalent conditions, the greatest declines were observed for children with CCCs hospitalized with respiratory illnesses. Despite declines in admissions, overall hospital-level outcomes remained similar.
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