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Health Services Use for SARS-CoV-2-Infected Children With Croup or Bronchiolitis
Amy Tyler1, Leigh Anne Bakel2, Joshua Tucker3
1Department of Pediatrics (Hospital Medicine), Nationwide Children's Hospital, Columbus, Ohio.
Insights
Children hospitalized for croup or bronchiolitis with concurrent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection did not show increased healthcare utilization. This finding suggests no significant impact on hospital resources for these pediatric respiratory illnesses during the pandemic.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Health services research
Background:
- Croup and bronchiolitis are common pediatric hospitalizations.
- The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on these conditions is not well understood.
- Understanding healthcare utilization is crucial for resource allocation.
Purpose of the Study:
- To compare healthcare utilization for pediatric croup and bronchiolitis patients with and without SARS-CoV-2 infection.
- To analyze hospitalization, readmission, length of stay, and ICU admission rates.
- To assess outcomes across different SARS-CoV-2 variant periods.
Main Methods:
- Retrospective cohort study using PEDSnet electronic health record data.
- Inclusion of children aged 30 days to 14 years diagnosed with croup or bronchiolitis.
- Analysis divided into pre-delta, delta, and omicron variant periods (March 2020-May 2022).
- Multivariable mixed effects models used to determine adjusted odds ratios.
Main Results:
- 9.65% of croup and 3.92% of bronchiolitis patients were SARS-CoV-2 positive.
- The omicron variant period saw the highest SARS-CoV-2 cases for both conditions.
- No statistically significant differences in utilization outcomes were found between SARS-CoV-2 positive and negative groups after controlling for variables.
Conclusions:
- Pediatric patients with croup/bronchiolitis and SARS-CoV-2 did not have significantly increased hospital or ICU admissions.
- Findings may inform future healthcare staffing models and public health recommendations.
- Further research on the long-term effects and specific variant impacts is warranted.
Background And Objectives:
Croup and bronchiolitis are common reasons for hospitalization in children, and the role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on utilization outcomes for these conditions is not well understood. To compare health care utilization including the rates of hospitalization, readmission, length of stay, and ICU admission for croup and bronchiolitis in children with and without evidence of concurrent SARS-CoV-2 infection over the pandemic period.
Methods:
This retrospective cohort study used inpatient and outpatient electronic health record data from PEDSnet institutions to examine health services use for children aged 30 days to 14 years with SARS-CoV-2 infection and diagnosed with croup or bronchiolitis. The time frame (March 2020-May 2022) was divided into predelta, delta, and omicron variant periods. Multivariable mixed effects logistic and log gamma regression models were used to calculate adjusted odds ratios for factors linked to utilization outcomes for children with versus without SARS-CoV-2 infections. Disease burden was described by variant time period.
Results:
Across all time periods, among subjects with croup and bronchiolitis, 9.65% of croup patients and 3.92% of bronchiolitis patients were SARS-CoV-2-positive. The omicron variant period had the highest number of SARS-CoV-2 cases for both croup and bronchiolitis. After controlling for patient-level variables and hospital variability, we found no statistically significant differences in utilization outcomes comparing children with and without SARS-CoV-2.
Conclusions:
Pediatric patients with croup and bronchiolitis and positive SARS-CoV-2 polymerase chain reaction testing did not exhibit a significant increase in hospital and ICU admissions, which may have implications for future staffing models and public health recommendations.
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