tetano
Editor, Senior Moderator
Pediatr Crit Care Med
. 2022 Nov 17.
doi: 10.1097/PCC.0000000000003105. Online ahead of print.
Trends in Disease Severity Among Critically Ill Children With Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Multicenter Cohort Study in the United States
Catherine E Ross[SUP] 1 2 [/SUP], Jeffrey P Burns[SUP] 2 [/SUP], Anne V Grossestreuer[SUP] 3 [/SUP], Pallav Bhattarai[SUP] 4 [/SUP], Christine A McKiernan[SUP] 4 [/SUP], Jennifer D Franks[SUP] 2 5 [/SUP], Sonja Lehmann[SUP] 6 [/SUP], Jill L Sorcher[SUP] 7 [/SUP], Matthew P Sharron[SUP] 8 [/SUP], Kitman Wai[SUP] 8 [/SUP], Haitham Al-Wahab[SUP] 9 [/SUP], Konstantinos Boukas[SUP] 9 [/SUP], Mark W Hall[SUP] 10 [/SUP], George Ru[SUP] 11 [/SUP], Anita I Sen[SUP] 11 [/SUP], Hariprem R Rajasekhar[SUP] 12 [/SUP], Lawrence C Kleinman[SUP] 13 [/SUP], John K McGuire[SUP] 14 [/SUP], Amy S Arrington[SUP] 15 [/SUP], Flor Munoz-Rivas[SUP] 15 [/SUP], Christopher M Osborne[SUP] 15 [/SUP], Lara S Shekerdemian[SUP] 15 [/SUP]
Affiliations
Abstract
Objectives: To describe trends in critical illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children over the course of the COVID-19 pandemic. We hypothesized that PICU admission rates were higher in the Omicron period compared with the original outbreak but that fewer patients needed endotracheal intubation.
Design: Retrospective cohort study.
Setting: This study took place in nine U.S. PICUs over 3 weeks in January 2022 (Omicron period) compared with 3 weeks in March 2020 (original period).
Patients: Patients less than or equal to 21 years old who screened positive for SARS-CoV-2 infection by polymerase chain reaction or hospital-based rapid antigen test and were admitted to a PICU or intermediate care unit were included.
Interventions: None.
Measurements and main results: A total of 267 patients (239 Omicron and 28 original) were reviewed. Forty-five patients in the Omicron cohort had incidental SARS-CoV-2 and were excluded from analysis. The Omicron cohort patients were younger compared with the original cohort patients (median [interquartile range], 6 yr [1.3-13.3 yr] vs 14 yr [8.3-17.3 yr]; p = 0.001). The Omicron period, compared with the original period, was associated with an average increase in COVID-19-related PICU admissions of 13 patients per institution (95% CI, 6-36; p = 0.008), which represents a seven-fold increase in the absolute number admissions. We failed to identify an association between cohort period (Omicron vs original) and odds of intubation (odds ratio, 0.7; 95% CI, 0.3-1.7). However, we cannot exclude the possibility of up to 70% reduction in intubation.
Conclusions: COVID-19-related PICU admissions were seven times higher in the Omicron wave compared with the original outbreak. We could not exclude the possibility of up to 70% reduction in use of intubation in the Omicron versus original epoch, which may represent differences in PICU/hospital admission policy in the later period, or pattern of disease, or possibly the impact of vaccination.
. 2022 Nov 17.
doi: 10.1097/PCC.0000000000003105. Online ahead of print.
Trends in Disease Severity Among Critically Ill Children With Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Multicenter Cohort Study in the United States
Catherine E Ross[SUP] 1 2 [/SUP], Jeffrey P Burns[SUP] 2 [/SUP], Anne V Grossestreuer[SUP] 3 [/SUP], Pallav Bhattarai[SUP] 4 [/SUP], Christine A McKiernan[SUP] 4 [/SUP], Jennifer D Franks[SUP] 2 5 [/SUP], Sonja Lehmann[SUP] 6 [/SUP], Jill L Sorcher[SUP] 7 [/SUP], Matthew P Sharron[SUP] 8 [/SUP], Kitman Wai[SUP] 8 [/SUP], Haitham Al-Wahab[SUP] 9 [/SUP], Konstantinos Boukas[SUP] 9 [/SUP], Mark W Hall[SUP] 10 [/SUP], George Ru[SUP] 11 [/SUP], Anita I Sen[SUP] 11 [/SUP], Hariprem R Rajasekhar[SUP] 12 [/SUP], Lawrence C Kleinman[SUP] 13 [/SUP], John K McGuire[SUP] 14 [/SUP], Amy S Arrington[SUP] 15 [/SUP], Flor Munoz-Rivas[SUP] 15 [/SUP], Christopher M Osborne[SUP] 15 [/SUP], Lara S Shekerdemian[SUP] 15 [/SUP]
Affiliations
- PMID: 36516349
- DOI: 10.1097/PCC.0000000000003105
Abstract
Objectives: To describe trends in critical illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children over the course of the COVID-19 pandemic. We hypothesized that PICU admission rates were higher in the Omicron period compared with the original outbreak but that fewer patients needed endotracheal intubation.
Design: Retrospective cohort study.
Setting: This study took place in nine U.S. PICUs over 3 weeks in January 2022 (Omicron period) compared with 3 weeks in March 2020 (original period).
Patients: Patients less than or equal to 21 years old who screened positive for SARS-CoV-2 infection by polymerase chain reaction or hospital-based rapid antigen test and were admitted to a PICU or intermediate care unit were included.
Interventions: None.
Measurements and main results: A total of 267 patients (239 Omicron and 28 original) were reviewed. Forty-five patients in the Omicron cohort had incidental SARS-CoV-2 and were excluded from analysis. The Omicron cohort patients were younger compared with the original cohort patients (median [interquartile range], 6 yr [1.3-13.3 yr] vs 14 yr [8.3-17.3 yr]; p = 0.001). The Omicron period, compared with the original period, was associated with an average increase in COVID-19-related PICU admissions of 13 patients per institution (95% CI, 6-36; p = 0.008), which represents a seven-fold increase in the absolute number admissions. We failed to identify an association between cohort period (Omicron vs original) and odds of intubation (odds ratio, 0.7; 95% CI, 0.3-1.7). However, we cannot exclude the possibility of up to 70% reduction in intubation.
Conclusions: COVID-19-related PICU admissions were seven times higher in the Omicron wave compared with the original outbreak. We could not exclude the possibility of up to 70% reduction in use of intubation in the Omicron versus original epoch, which may represent differences in PICU/hospital admission policy in the later period, or pattern of disease, or possibly the impact of vaccination.