Department of Pediatrics, Indiana University of School of Medicine, Indianapolis, IN.
Department of Pediatrics, Stanford University, Palo Alto, CA.
Pediatr Crit Care Med. 2022 Jul 1;23(7):535-543. doi: 10.1097/PCC.0000000000002967. Epub 2022 Apr 21.
To determine the association between nationwide school closures and prevalence of common admission diagnoses in the pediatric critical care unit.
Retrospective cohort study.
National database evaluation using the Virtual Pediatric Systems LLC database.
All patients admitted to the PICU in 81 contributing hospitals in the United States.
Diagnosis categories were determined for all 110,418 patients admitted during the 20-week study period in each year (2018, 2019, and 2020). Admission data were normalized relative to statewide school closure dates for each patient using geographic data. The "before school closure" epoch was defined as 8 weeks prior to school closure, and the "after school closure" epoch was defined as 12 weeks following school closure. For each diagnosis, admission ratios for each study day were calculated by dividing 2020 admissions by 2018-2019 admissions. The 10 most common diagnosis categories were examined. Significant changes in admission ratios were identified for bronchiolitis, pneumonia, and asthma. These changes occurred at 2, 8, and 35 days following school closure, respectively. PICU admissions decreased by 82% for bronchiolitis, 76% for pneumonia, and 76% for asthma. Nonrespiratory diseases such as diabetic ketoacidosis, status epilepticus, traumatic injury, and poisoning/ingestion did not show significant changes following school closure.
School closures are associated with a dramatic reduction in the prevalence of severe respiratory disease requiring PICU admission. School closure may be an effective tool to mitigate future pandemics but should be balanced with potential academic, economic, mental health, and social consequences.
确定全国范围内学校关闭与儿科重症监护病房常见入院诊断之间的相关性。
回顾性队列研究。
使用 Virtual Pediatric Systems LLC 数据库对全国数据库进行评估。
美国 81 家参与医院收治的所有 PICU 患者。
在每年（2018 年、2019 年和 2020 年）的 20 周研究期间，确定了所有 110418 名入院患者的诊断类别。使用地理数据，根据每个患者的全州学校关闭日期对入院数据进行标准化。“学校关闭前”时期定义为学校关闭前 8 周，“学校关闭后”时期定义为学校关闭后 12 周。对于每个诊断，通过将 2020 年的入院人数除以 2018-2019 年的入院人数，计算每个研究日的入院比例。研究了 10 个最常见的诊断类别。发现毛细支气管炎、肺炎和哮喘的入院比例发生了显著变化。这些变化分别发生在学校关闭后 2、8 和 35 天。毛细支气管炎、肺炎和哮喘的 PICU 入院率分别下降了 82%、76%和 76%。糖尿病酮症酸中毒、癫痫持续状态、创伤性损伤和中毒/摄入等非呼吸道疾病在学校关闭后没有显示出显著变化。
学校关闭与需要 PICU 入院的严重呼吸道疾病的患病率显著降低有关。学校关闭可能是减轻未来大流行的有效工具，但应权衡其对学术、经济、心理健康和社会的潜在影响。
