Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio, USA.
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Hosp Med. 2023 Jan;18(1):33-42. doi: 10.1002/jhm.13021. Epub 2022 Dec 12.
Children with neurologic impairment (NI) are frequently hospitalized for infectious and noninfectious illnesses. The early period of the COVID-19 pandemic was associated with overall lower pediatric hospitalization rates, particularly for respiratory infections, but the effect on utilization for children with NI is unknown.
This multicenter retrospective cohort study included hospitalizations of children 1-18 years of age with NI diagnosis codes from 49 children's hospitals. We calculated the percent change in the median weekly hospitalization volumes and the hospitalization resource intensity score (H-RISK), comparing the early-COVID era (March 15, 2020 to December 31, 2020) with the pre-COVID era (same timeframe of 2017-2019). Percent change was calculated over the entire study period as well as within three seasonal time periods (spring, summer, and fall/winter). Differences between infectious and noninfectious admission diagnoses were also examined.
Compared with the pre-COVID era, there was a 14.4% decrease (interquartile range [IQR]: -33.8, -11.7) in the weekly median number of hospitalizations in the early-COVID era; the weekly median H-RISK score was 11.7% greater (IQR: 8.9, 14.9). Hospitalizations decreased for both noninfectious (-11.6%, IQR: -30.0, -8.0) and infectious (-35.5%, IQR: -51.1, -31.3) illnesses in the early-COVID era. This decrease was the largest in spring 2020 and continued throughout 2020.
For children with NI, there was a substantial and significant decrease in hospitalizations for infectious and noninfectious diagnoses but an increase in illness severity during the early-COVID era compared with the pre-COVID era. Our data suggest a need to reconsider current thresholds for hospitalization and identify opportunities to support and guide families through certain illnesses without hospitalization.
患有神经损伤（NI）的儿童经常因感染和非感染性疾病住院。COVID-19 大流行的早期阶段与儿科住院率总体下降有关，特别是与呼吸道感染有关，但对患有 NI 的儿童的利用情况的影响尚不清楚。
这项多中心回顾性队列研究纳入了来自 49 家儿童医院的患有 NI 诊断代码的 1-18 岁儿童的住院病例。我们计算了每周中位住院量和住院资源强度评分（H-RISK）的中位数百分比变化，比较了 COVID-19 早期（2020 年 3 月 15 日至 2020 年 12 月 31 日）与 COVID-19 前（同一时期为 2017-2019 年）时期。计算了整个研究期间以及三个季节性时间段（春季、夏季和秋季/冬季）的百分比变化。还检查了感染性和非感染性入院诊断之间的差异。
与 COVID-19 前时期相比，COVID-19 早期时期每周中位住院人数减少了 14.4%（四分位距[IQR]：-33.8，-11.7）；每周中位 H-RISK 评分增加了 11.7%（IQR：8.9，14.9）。非传染性疾病（-11.6%，IQR：-30.0，-8.0）和传染性疾病（-35.5%，IQR：-51.1，-31.3）的住院人数在 COVID-19 早期时期均减少。这种下降在 2020 年春季最大，并持续到 2020 年全年。
对于患有 NI 的儿童，与 COVID-19 前时期相比，在 COVID-19 早期时期，感染性和非感染性疾病的住院人数大幅且显著减少，但疾病严重程度有所增加。我们的数据表明，有必要重新考虑目前的住院阈值，并确定机会，在无需住院的情况下，为家庭提供支持和指导，以应对某些疾病。
