Infectious Diseases, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia.
Arch Dis Child. 2023 Jul;108(7):e11. doi: 10.1136/archdischild-2022-325004. Epub 2023 Feb 24.
During the COVID-19 pandemic, we expanded our Hospital-in-the-Home (HITH) programme to increase capacity and manage COVID-19-positive children. We aimed to assess impact on overall HITH activity and COVID-19-positive outcomes.
Prospective comparative cohort study.
The largest paediatric HITH in Australasia, at The Royal Children's Hospital Melbourne.
Children 0-18 years admitted to HITH during the pandemic.
We developed a COVID-19 responsive service, and a guideline for COVID-19-positive patients. We compared overall activity prior to and during the pandemic, and COVID-19-positive admissions with different variants.
We compared outcomes for all HITH patients before and during the pandemic, and for COVID-19-positive patients admitted first to hospital versus directly to HITH.
HITH managed 7319 patients from March 2020 to March 2022, a 21% increase to previously, with a 132% telehealth increase. 421 COVID-19-positive patients (3 days-18.9 years) were admitted to HITH, predominantly high risk (63%) or moderately unwell (33%). Rates of childhood infection in Victoria, with proportion admitted to HITH were: original/alpha variant-3/100 000/month, 0.7%; delta-92/100 000/month, 0.8%; omicron-593/100 000/month, 0.3%. Eligible parents of only 29 of 71 (41%) high-risk children were vaccinated. COVID-19-positive children admitted directly to HITH were less likely to receive COVID-19-specific treatment than those admitted to hospital first (14 of 113 (12%) vs 33 of 46 (72%), p<0.001), reflecting more severe respiratory, but not other features in inpatients. 15 of 159 (10%) were readmitted to hospital, but none deteriorated rapidly.
COVID-19-positive children at high risk or with moderate symptoms can be managed safely via HITH at home, the ideal place for children during the pandemic.
在 COVID-19 大流行期间，我们扩大了医院内居家治疗（HITH）项目，以增加容量并管理 COVID-19 阳性儿童。我们旨在评估其对整体 HITH 活动和 COVID-19 阳性结果的影响。
前瞻性比较队列研究。
澳大利亚最大的儿科 HITH，位于墨尔本皇家儿童医院。
在大流行期间入住 HITH 的 0-18 岁儿童。
我们开发了一种针对 COVID-19 的响应服务和针对 COVID-19 阳性患者的指南。我们比较了大流行前和大流行期间的整体活动，以及不同变体的 COVID-19 阳性入院。
我们比较了大流行前和大流行期间所有 HITH 患者的结果，以及首先住院和直接住院的 COVID-19 阳性患者的结果。
HITH 在 2020 年 3 月至 2022 年 3 月期间管理了 7319 名患者，比之前增加了 21%，远程医疗增加了 132%。421 名 COVID-19 阳性患者（3 天-18.9 岁）入住 HITH，主要为高危（63%）或中度不适（33%）。维多利亚州儿童感染率，住院率为：原始/alpha 变体-3/100000 例/月，0.7%；delta-92/100000 例/月，0.8%；omicron-593/100000 例/月，0.3%。高危儿童中只有 29 名（41%）符合条件的父母接种了疫苗。直接入住 HITH 的 COVID-19 阳性儿童接受 COVID-19 特异性治疗的可能性低于先住院的儿童（113 例中的 14 例（12%）与 46 例中的 33 例（72%），p<0.001），这反映了住院患者呼吸更严重，但其他特征无差异。159 例中有 15 例（10%）再次住院，但均无病情迅速恶化。
高危或中度症状的 COVID-19 阳性儿童可以在家中通过 HITH 安全管理，这是大流行期间儿童的理想场所。
