Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Health Informatics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Netw Open. 2021 Feb 1;4(2):e2037227. doi: 10.1001/jamanetworkopen.2020.37227.
In early 2020, the United States declared a public health emergency in response to coronavirus disease 2019 (COVID-19) and implemented a variety of social distancing measures. The association between the COVID-19 pandemic and the number of pediatric admissions is unclear.
To determine the changes in patterns of pediatric admissions in 2020 compared with the prior decade.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 49 US hospitals contributing to the Pediatric Health Information Systems database. Inpatient admissions were transformed into time-series data, and ensemble forecasting models were generated to analyze admissions across a range of diagnoses in 2020 compared with previous years. The setting was inpatient admissions. All patients discharged between January 1, 2010, and June 30, 2020, from an inpatient hospital encounter were included.
Number of hospital admissions by primary diagnosis for each encounter.
Of 5 424 688 inpatient encounters among 3 372 839 patients (median [interquartile range] age, 5.1 [0.7-13.3] years; 2 823 748 [52.1%] boys; 3 171 224 [58.5%] White individuals) at 49 hospitals, 213 571 (3.9%) were between January 1, 2020, and June 30, 2020. There was a decrease in the number of admissions beginning in March 2020 compared with the period from 2010 to 2019. At the nadir, admissions in April 2020 were reduced 45.4% compared with prior years (23 798 in April 2020 compared with a median [interquartile range] of 43 550 [42 110-43 946] in April 2010-2019). Inflation-adjusted hospital charges decreased 27.7% in the second quarter of 2020 compared with prior years ($4 327 580 511 in 2020 compared with a median [interquartile range] of $5 983 142 102 [$5 762 690 022-$6 324 978 456] in 2010-2019). Seasonal patterns were evident between 2010 and 2019 for a variety of common pediatric conditions, including asthma, atrial septal defects, bronchiolitis, diabetic ketoacidosis, Kawasaki syndrome, mental health admissions, and trauma. Ensemble models were able to discern seasonal patterns in admission diagnoses and accurately predicted admission rates from July 2019 until December 2019 but not from January 2020 to June 2020. All diagnoses except for birth decreased below the model 95% CIs between January 2020 and June 2020.
In this cross-sectional study, pediatric admissions to US hospitals decreased in 2020 across an array of pediatric conditions. Although some conditions may have decreased in incidence, others may represent unmet needs in pediatric care during the COVID-19 pandemic.
2020 年初，美国为应对 2019 年冠状病毒病（COVID-19）宣布了公共卫生紧急状态，并实施了各种社会隔离措施。COVID-19 大流行与儿科住院人数之间的关联尚不清楚。
确定与前十年相比，2020 年儿科住院人数的变化模式。
设计、地点和参与者：本横断面研究包括为儿科健康信息系统数据库提供数据的 49 家美国医院。将住院人数转换为时间序列数据，并生成综合预测模型，以分析 2020 年与前几年相比，各种诊断的住院人数。研究地点为住院病人。所有在 2010 年 1 月 1 日至 2020 年 6 月 30 日期间从住院医院就诊中出院的患者（中位数[四分位距]年龄为 5.1[0.7-13.3]岁；2823748[52.1%]男孩；3171224[58.5%]白种人）的 49 家医院共进行了 5424688 次住院治疗。
每次就诊的主要诊断的住院人数。
在 49 家医院中，3372839 名患者（中位数[四分位距]年龄为 5.1[0.7-13.3]岁；2823748[52.1%]男孩；3171224[58.5%]白种人）的 5424688 次住院治疗中，有 213571 次（3.9%）发生在 2020 年 1 月 1 日至 6 月 30 日期间。与 2010 年至 2019 年相比，2020 年 3 月开始，住院人数减少。在最低点，2020 年 4 月的住院人数比前几年减少了 45.4%（2020 年 4 月有 23798 人，而 2010-2019 年的中位数[四分位距]为 43550[42110-43946]）。与 2010 年至 2019 年相比，2020 年第二季度的通货膨胀调整后医院收费下降了 27.7%（2020 年为 4327580511 美元，中位数[四分位距]为 5983142102 美元[5762690022 美元-6324978456 美元]）。2010 年至 2019 年期间，各种常见儿科疾病（包括哮喘、房间隔缺损、细支气管炎、糖尿病酮症酸中毒、川崎病、心理健康入院和创伤）均存在季节性模式。综合模型能够辨别出入院诊断的季节性模式，并能够准确预测 2019 年 7 月至 2019 年 12 月的入院率，但不能预测 2020 年 1 月至 2020 年 6 月的入院率。除出生外，所有诊断均低于 2020 年 1 月至 6 月的模型 95%CI。
在这项横断面研究中，美国医院的儿科住院人数在 2020 年各种儿科疾病中均有所下降。尽管某些疾病的发病率可能有所下降，但其他疾病可能代表 COVID-19 大流行期间儿科护理方面的未满足需求。
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