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The Temporal Relationship Between Local School Closure and Increased Incidence of Pediatric Diabetic Ketoacidosis.
McCluskey, Casey K; Zee-Cheng, Janine E; Klein, Margaret J; Scanlon, Matthew C; Rotta, Alexandre T; Remy, Kenneth E; Carroll, Christopher L; Shein, Steven L.
  • McCluskey CK; Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, United States.
  • Zee-Cheng JE; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.
  • Klein MJ; Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, Los Angeles, CA, United States.
  • Scanlon MC; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States.
  • Rotta AT; Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States.
  • Remy KE; Department of Pediatrics and Internal Medicine, Washington University in St. Louis, St. Louis, MO, United States.
  • Carroll CL; Department of Pediatrics, Connecticut Children's, Hartford, CT, United States.
  • Shein SL; Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
Front Pediatr ; 10: 812265, 2022.
Article in English | MEDLINE | ID: covidwho-1775737
ABSTRACT
Importance The incidence of pediatric diabetic ketoacidosis (DKA) increased early in the COVID-19 pandemic, but the relative contribution of behavioral changes and viral-related pathophysiology are unknown.

Objective:

To evaluate the relationship between school closure date and onset of increased DKA to help clarify the etiology of the increased incidence.

Design:

A multi-center, quality-controlled Pediatric Intensive Care Unit (PICU) database was used to identify the number of admissions to a participating PICU with DKA on each calendar day from 60 days before local school closure to 90 days after, and compared to baseline data from the same periods in 2018-2019. Interrupted time series and multiple linear regression analyses were used to identify admission rates that differed significantly between 2020 and baseline.

Setting:

Eighty-one PICUs in the United States

Participants:

Children ages 29 days to 17 years admitted to a PICU with DKAExposures Statewide school closureMain outcome/

measure:

Rate of admission to the PICU for DKA.

Results:

There were 1936 admissions for children with DKA in 2020 and 1795 admissions/year to those same PICUs in 2018-2019. Demographics and clinical outcomes did not differ before school closure, but pandemic-era patients were less often white and had longer hospital length of stay in the post-school closure period. The difference between 2020 admissions and 2018-2019 admissions was not different than zero before school closure, and significantly higher than zero after school closure, but was significantly increased in 2020 at >30 days after school closure (p = 0.039). Conclusions/Relevance An increase in pediatric DKA admissions began one month after school closures. Given that behavioral changes started near school closure dates and viral activity peaked weeks after, this suggests that behavioral factors may not be the primary etiology and it is possible that SARS-CoV-2 infection may have direct effects on pediatric DKA.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Front Pediatr Year: 2022 Document Type: Article Affiliation country: Fped.2022.812265

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Front Pediatr Year: 2022 Document Type: Article Affiliation country: Fped.2022.812265