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The Impact of Strict Public Health Restrictions on Pediatric Critical Illness.
Maddux, Aline B; Campbell, Kristen; Woodruff, Alan G; LaVelle, Jaime; Lutmer, Jeffrey; Kennedy, Curt E; Malakooti, Marcelo; McGuire, John K; Shekerdemian, Lara; Harris, Z Leah; McCrory, Michael C; Carpenter, Todd C.
  • Maddux AB; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
  • Campbell K; Section of Pediatric Critical Care Medicine, Children's Hospital Colorado, Aurora, CO.
  • Woodruff AG; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
  • LaVelle J; Department of Anesthesiology, Section of Pediatric Critical Care Medicine, Wake Forest School of Medicine, Winston Salem, NC.
  • Lutmer J; Section of Pediatric Critical Care Medicine, Children's Hospital Colorado, Aurora, CO.
  • Kennedy CE; Nationwide Children's Hospital, Columbus, OH.
  • Malakooti M; Department of Pediatrics, Section of Pediatric Critical Care Medicine, The Ohio State University College of Medicine, Columbus, OH.
  • McGuire JK; Baylor College of Medicine, Houston, TX.
  • Shekerdemian L; Texas Children's Hospital, Houston, TX.
  • Harris ZL; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
  • McCrory MC; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
  • Carpenter TC; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
Crit Care Med ; 49(12): 2033-2041, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1522364
ABSTRACT

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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Intensive Care Units, Pediatric / Communicable Disease Control / COVID-19 Type of study: Controlled clinical trial / Observational study / Prognostic study / Risk factors Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Young adult Language: English Journal: Crit Care Med Year: 2021 Document Type: Article Affiliation country: CCM.0000000000005200

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Admission / Intensive Care Units, Pediatric / Communicable Disease Control / COVID-19 Type of study: Controlled clinical trial / Observational study / Prognostic study / Risk factors Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Young adult Language: English Journal: Crit Care Med Year: 2021 Document Type: Article Affiliation country: CCM.0000000000005200