Impact of coronavirus disease 2019 on pediatric intestinal intussusception in the United States.

BACKGROUND: Masking and social distancing to mitigate the spread of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus curbed the spread of other viruses. Given a potential link between viral illnesses and ileocolic intussusception, the purpose of this study is to characterize trends in incidence, diagnosis and management of pediatric intussusception in the United States in the context of the coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: This cross-sectional retrospective study used the Pediatric Hospital Information System and included children (ages 0-17 years) with a primary diagnosis of intussusception (ICD-10 [International Classification of Diseases, Tenth Revision]: K56.1) from January 2018 to December 2021. Descriptive statistics and chi-square analyses were used to characterize and compare proportions pre-COVID (2018 and 2019) to 2020 and 2021. RESULTS: Eight thousand one hundred forty-three encounters met inclusion criteria. Intussusception diagnoses declined in 2020 (n = 1,480) compared to 2019 (n = 2,321) and 2018 (n = 2,171) but returned to pre-COVID levels in 2021 (n = 2,171). Patient age was similar across years (mean age in years: 2018: 2.3; 2019: 2.1; 2020: 2.3; 2021: 2.3). There was no significant change in the proportion of patients who underwent imaging in 2020 (96% [1,415/1,480]) compared to the other years in the study (2018: 96% [2,093/2,171], P = 0.21; 2019: 97% [2,253/2,321], P = 0.80; 2021: 96% [1,415/1,480], P = 0.85). There was a statistically significant but minimal increase in the proportion of cases treated with surgery in 2020 compared to 2019 (2020: 17.8% vs. 2019: 15%, P = 0.02); however, this was not replicated in the pairwise comparison of 2020 to 2018 (2020: 17.8% vs. 2018: 16.4%, P = 0.23). There was a statistically significant increase in the proportion of cases treated with surgery in 2020 compared to 2021 (2020: 17.8% vs. 2021: 14%, P = 0.001). CONCLUSION: Pediatric intussusception diagnoses decreased at a national level in 2020 compared to previous years, with a rebound increase in 2021. This may reflect a secondary benefit of public health interventions imposed to curb the spread of COVID-19.

The impact of public health interventions on critical illness in the pediatric emergency department during the SARS-CoV-2 pandemic.

Study objective: The impact of public health interventions during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on critical illness in children has not been studied. We seek to determine the impact of SARS-CoV-2 related public health interventions on emergency healthcare utilization and frequency of critical illness in children. Methods: This was an interrupted time series analysis conducted at a single tertiary pediatric emergency department (PED). All patients evaluated by a provider from December 31 through May 14 of 6 consecutive years (2015-2020) were included. Total patient visits (ED and urgent care), shock trauma suite (STS) volume, and measures of critical illness were compared between the SARS-CoV-2 period (December 31, 2019 to May 14, 2020) and the same period for the previous 5 years combined. A segmented regression model was used to explore differences in the 3 outcomes between the study and control period. Results: Total visits, STS volume, and volume of critical illness were all significantly lower during the SARS-CoV-2 period. During the height of public health interventions, per day there were 151 fewer total visits and 7 fewer patients evaluated in the STS. The odds of having a 24-hour period without a single critical patient were >5 times higher. Trends appeared to start before the statewide shelter-in-place order and lasted for at least 8 weeks. Conclusions: In a metropolitan area without significant SARS-CoV-2 seeding, the pandemic was associated with a marked reduction in PED visits for critical pediatric illness.