Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Australia.
Eastern Health Intensive Care Research Centre, Eastern Health, Melbourne, Australia.
JAMA Netw Open. 2022 May 2;5(5):e2211692. doi: 10.1001/jamanetworkopen.2022.11692.
Identification of potential indirect outcomes associated with the COVID-19 pandemic in the pediatric population may be essential for understanding the challenges of the current global public health crisis for children and adolescents.
To investigate whether the SARS-CoV-2 outbreak and subsequent effective public health measures in Australia were associated with an increase in admissions to intensive care units (ICUs) of children and adolescents with deliberate self-harm (DSH).
DESIGN, SETTING, AND PARTICIPANTS: This national, multicenter cohort study was conducted using the Australian data subset of the binational Australian and New Zealand Paediatric Intensive Care registry, a collaborative containing more than 200 000 medical records with continuous contributions from all 8 Australian specialist, university-affiliated pediatric ICUs, along with 1 combined neonatal-pediatric ICU and 14 general (adult) ICUs in Australia. The study period encompassed 6.5 years from January 1, 2015, to June 30, 2021. Patients aged 12 to 17 years were included. Data were analyzed from December 2021 through February 2022.
Any of the following admission diagnoses: ingestion of a drug, ingestion of a nondrug, hanging or strangulation, or self-injury.
The primary outcome measure was the temporal trend for national incidence of DSH ICU admissions per 1 million children and adolescents aged 12 to 17 years in Australia.
A total of 813 children and adolescents aged 12 to 17 years admitted to ICUs with DSH were identified among 64 145 patients aged 0 to 17 years in the Australian subset of the registry during the study period. Median (IQR) age was 15.1 (14.3-15.8) years; there were 550 (67.7%) female patients, 261 (32.2%) male patients, and 2 (0.2%) patients with indeterminate sex. At the onset of the pandemic, monthly incidence of DSH ICU admissions per million children and adolescents increased from 7.2 admissions in March 2020 to a peak of 11.4 admissions by August 2020, constituting a significant break in the temporal trend (odds ratio of DSH ICU admissions on or after vs before March 2020, 4.84; 95% CI, 1.09 to 21.53; P = .04). This occurred while the rate of all-cause admissions to pediatric ICUs of children and adolescents of all ages (ie, ages 0-17 years) per 1 million children and adolescents decreased from a long-term monthly median (IQR) of 150.9 (138.1-159.8) admissions to 91.7 admissions in April 2020.
This cohort study found that the coronavirus pandemic in Australia was associated with a significant increase in admissions of children and adolescents to intensive care with DSH.
确定与 COVID-19 大流行相关的潜在间接结果，可能对于了解当前全球儿童和青少年公共卫生危机的挑战至关重要。
调查 SARS-CoV-2 爆发以及澳大利亚随后采取的有效公共卫生措施是否与 12 至 17 岁儿童和青少年因故意自我伤害（DSH）而入住重症监护病房（ICU）的人数增加有关。
设计、地点和参与者：这是一项全国性、多中心队列研究，使用澳大利亚-新西兰儿科重症监护登记处的澳大利亚子数据集进行，该登记处是一个合作项目，包含超过 20 万份病历，由澳大利亚所有 8 个专业、大学附属儿科 ICU 以及澳大利亚的 1 个新生儿-儿科 ICU 和 14 个普通（成人）ICU 持续提供数据。研究期间为 2015 年 1 月 1 日至 2021 年 6 月 30 日。纳入年龄在 12 至 17 岁之间的患者。数据分析于 2021 年 12 月至 2022 年 2 月进行。
任何以下入院诊断：摄入药物、摄入非药物、上吊或勒死、或自我伤害。
主要结局指标是澳大利亚每 100 万 12 至 17 岁儿童和青少年中因 DSH 而入住 ICU 的全国发病率的时间趋势。
在研究期间，澳大利亚子集中登记处的 64145 名 0 至 17 岁患者中，有 813 名 12 至 17 岁因 DSH 而入住 ICU 的儿童和青少年。中位（IQR）年龄为 15.1（14.3-15.8）岁；550 名（67.7%）为女性患者，261 名（32.2%）为男性患者，2 名（0.2%）患者性别不确定。大流行开始时，每月因 DSH 而入住 ICU 的儿童和青少年每百万儿童和青少年的发病率从 2020 年 3 月的 7.2 例上升至 2020 年 8 月的 11.4 例高峰，这是一个显著的时间趋势中断（2020 年 3 月或之后与 2020 年 3 月之前相比，DSH ICU 入院的比值比，4.84；95%CI，1.09 至 21.53；P =.04）。与此同时，所有年龄（即 0-17 岁）儿童和青少年因所有原因入住儿科 ICU 的比率从长期每月中位数（IQR）的 150.9（138.1-159.8）降至 2020 年 4 月的 91.7 例。
这项队列研究发现，澳大利亚的冠状病毒大流行与儿童和青少年因 DSH 而入住 ICU 的人数显著增加有关。
