National Trends in Pediatric Critical Asthma Severity during the Covid-19 Pandemic

ABSTRACT

INTRODUCTION: Asthma exacerbations in children have historically been attributed to a combination of viral infection, environmental exposures, and individual patient attributes. The COVID-19 pandemic has provided a unique opportunity to evaluate variations in asthma severity during a time of changing viral exposure patterns and patient behaviors. This study describes the trends in pediatric critical asthma severity during the COVID-19 pandemic. METHOD(S) We performed a retrospective analysis of the Virtual Pediatric Systems (VPS) database. Inclusion criteria were patients admitted to a pediatric intensive care unit in the United States from 2014-2021 with a discharge diagnosis of "asthma with acute exacerbation" or "asthma with status asthmaticus." Asthma severity was determined by the maximum level of respiratory support required during the admission, from lowest to highest 1-Heated high flow nasal cannula;2-Non-invasive positive pressure;3-Endotracheal intubation;4-Inhaled anesthetics or ECMO. Patients were divided into Pre-COVID, Pandemic Era 2020, and 2021 groups based on the date of admission, with the start of the COVID-19 pandemic defined as April 1, 2020. Subgroup analysis was performed based on race/ethnic group. RESULT(S) A total of 51,746 patients were identified in the VPS database that met the stated criteria. The average number of admissions per month was 713 and 206 in the Pre-COVID and Pandemic groups, respectively. Patients categorized as "Severe" (severity levels 3 & 4) represented 3.8% and 4.7% of admissions, respectively (p< 0.05). Patients categorized as "Moderate" (severity level 2) represented 16.9% and 21.7% of admissions, respectively (p< 0.05). Asthma mortality rates were found to be 0.3% and 0.7%, respectively (p< 0.05). Subgroup analysis by race/ ethnic group found that asthma severity by race/ethnicity was unchanged from the pre-COVID baseline. CONCLUSION(S) During the COVID-19 pandemic, the number of critical asthma admissions decreased while the average severity and mortality rate in those patients increased. Further study is needed to determine whether these findings are due to delayed presentation to healthcare, changes in viral exposure patterns, or other factors.