In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire.
Admission patterns
COVID19
Case mix
Paediatric intensive care unit
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
17 11 2021
17 11 2021
Historique:
received:
26
07
2021
accepted:
30
09
2021
entrez:
18
11
2021
pubmed:
19
11
2021
medline:
23
11
2021
Statut:
epublish
Résumé
The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. We performed a retrospective cohort study of all admissions to PICUs in children < 18 years during Jan-Dec 2020, using data collected from 32 PICUs via a central database (PICANet). Admission patterns, case-mix, resource use, and outcomes were compared with the four preceding years (2016-2019) based on the date of admission. There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340-20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016-2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5-3.4) vs. 1.2 (0.5-3.4) %], length of stay [2.3 (1.0-5.5) vs. 2.4 (1.0-5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91-1.11, p = 0.93])] were similar between 2016-2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016-2019 (n = 711). The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.
Sections du résumé
BACKGROUND
The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland.
METHODS
We performed a retrospective cohort study of all admissions to PICUs in children < 18 years during Jan-Dec 2020, using data collected from 32 PICUs via a central database (PICANet). Admission patterns, case-mix, resource use, and outcomes were compared with the four preceding years (2016-2019) based on the date of admission.
RESULTS
There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340-20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016-2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5-3.4) vs. 1.2 (0.5-3.4) %], length of stay [2.3 (1.0-5.5) vs. 2.4 (1.0-5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91-1.11, p = 0.93])] were similar between 2016-2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016-2019 (n = 711).
CONCLUSIONS
The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.
Identifiants
pubmed: 34789305
doi: 10.1186/s13054-021-03779-z
pii: 10.1186/s13054-021-03779-z
pmc: PMC8597872
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
399Informations de copyright
© 2021. The Author(s).
Références
Science. 2021 Feb 19;371(6531):
pubmed: 33323424
Arch Dis Child. 2021 Sep;106(9):911-917
pubmed: 33451994
Crit Care Explor. 2021 Mar 15;3(3):e0362
pubmed: 33786438
Arch Dis Child. 2020 Oct 7;:
pubmed: 33028512
Euro Surveill. 2020 Nov;25(47):
pubmed: 33243355
Lancet Reg Health Eur. 2021 Apr;3:100075
pubmed: 34027512
Public Health Rep. 2010 Mar-Apr;125(2):178-91
pubmed: 20297744
Intensive Care Med. 2021 Jun;47(6):698-700
pubmed: 33904948
Lancet Child Adolesc Health. 2020 Aug;4(8):e32-e33
pubmed: 32598871
Clin Infect Dis. 2021 Jun 15;72(12):2199-2202
pubmed: 32986804
Int J Infect Dis. 2021 Jan;102:247-253
pubmed: 33129965
Clin Infect Dis. 2021 Nov 2;73(9):e2829-e2830
pubmed: 33594407
Pediatr Crit Care Med. 2021 Feb 1;22(2):e125-e134
pubmed: 33027239
Paediatr Child Health. 2021 Apr 08;26(4):208-209
pubmed: 34127934
Arch Dis Child. 2021 Apr;106(4):e21
pubmed: 32938625
BMJ. 2008 Jan 12;336(7635):77-80
pubmed: 18042961
Pediatr Crit Care Med. 2013 Sep;14(7):673-81
pubmed: 23863821
Arch Dis Child. 2021 Jun;106(6):548-557
pubmed: 33509793
Lancet Child Adolesc Health. 2021 May;5(5):e12-e13
pubmed: 33713603
World J Pediatr Congenit Heart Surg. 2020 Nov;11(6):689-696
pubmed: 32844725
Arch Dis Child. 2021 Feb;106(2):e8
pubmed: 32586927
JAMA Pediatr. 2020 Sep 01;174(9):868-873
pubmed: 32392288
Chest. 2021 Aug;160(2):529-537
pubmed: 33727033
Arch Dis Child. 2022 Jan;107(1):14-20
pubmed: 34911683