美国儿童医院 COVID-19 期间先天性巨结肠相关性结肠炎发病率降低。
Decreased Incidence of Hirschsprung-Associated Enterocolitis During COVID-19 Across United States Children's Hospitals.
机构信息
Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
出版信息
J Pediatr Surg. 2023 Sep;58(9):1694-1698. doi: 10.1016/j.jpedsurg.2023.02.004. Epub 2023 Feb 15.
BACKGROUND
The Coronavirus Disease 2019 pandemic provided a natural experiment to study the effect of social distancing on the risk of developing Hirschsprung's Associated Enterocolitis (HAEC).
METHODS
Using the Pediatric Health Information System (PHIS), a retrospective cohort study of children (<18 years) with Hirschsprung's Disease (HSCR) across 47 United States children's hospitals was performed. The primary outcome was HAEC admissions per 10,000 patient-days. The exposure (COVID-19) was defined as April 2020-December 2021. The unexposed (historical control) period was April 2018-December 2019. Secondary outcomes included sepsis, bowel perforation, intensive care unit (ICU) admission, mortality, and length of stay.
RESULTS
Overall, we included 5707 patients with HSCR during the study period. There were 984 and 834 HAEC admissions during the pre-pandemic and pandemic periods, respectively (2.6 vs. 1.9 HAEC admissions per 10,000 patient-days, incident rate ratio [95% confidence interval]: 0.74 [0.67, 0.81], p < 0.001). Compared to pre-pandemic, those with HAEC during the pandemic were younger (median [IQR]: 566 [162, 1430] days pandemic vs. 746 [259, 1609] days pre-pandemic, p < 0.001) and more likely to live in the lowest quartile of median household income zip codes (24% pandemic vs. 19% pre-pandemic, p = 0.02). There were no significant differences in rates of sepsis (6.1% pandemic vs. 6.1% pre-pandemic, p > 0.9), bowel perforation (1.3% pandemic vs. 1.2% pre-pandemic, p = 0.8), ICU admissions (9.6% pandemic vs. 12% pre-pandemic, p = 0.2), mortality (0.5% pandemic vs. 0.6% pre-pandemic, p = 0.8), or length of stay (median [interquartile range]: 4 [(Pastor et al., 2009; Gosain and Brinkman, 2015) 2,112,11 days pandemic vs. 5 [(Pastor et al., 2009; Tang et al., 2020) 2,102,10 days pre-pandemic, p = 0.4).
CONCLUSIONS
The COVID-19 pandemic was associated with significantly decreased incidence of HAEC admissions across US children's hospitals. Possible etiologies such as social distancing should be explored.
LEVEL OF EVIDENCE
II.
背景
2019 年冠状病毒病大流行提供了一个自然实验，以研究社交距离对先天性巨结肠相关结肠炎（HAEC）发病风险的影响。
方法
利用小儿健康信息系统（PHIS），对美国 47 家儿童医院的先天性巨结肠（HSCR）患儿进行了回顾性队列研究。主要结局是每 10000 个患者日发生 HAEC 入院的人数。暴露（COVID-19）定义为 2020 年 4 月至 2021 年 12 月。未暴露（历史对照）期为 2018 年 4 月至 2019 年 12 月。次要结局包括败血症、肠穿孔、重症监护病房（ICU）入院、死亡率和住院时间。
结果
研究期间，共纳入 5707 例 HSCR 患儿。在大流行前和大流行期间分别有 984 例和 834 例 HAEC 入院（每 10000 个患者日分别为 2.6 例和 1.9 例 HAEC 入院，发病率比[95%置信区间]：0.74[0.67,0.81]，p<0.001）。与大流行前相比，大流行期间发生 HAEC 的患儿年龄更小（中位数[四分位距]：566[162,1430]天大流行 vs. 746[259,1609]天大流行前，p<0.001），更可能居住在中等家庭收入邮政编码的最低四分位数（24%大流行 vs. 19%大流行前，p=0.02）。败血症（6.1%大流行 vs. 6.1%大流行前，p>0.9）、肠穿孔（1.3%大流行 vs. 1.2%大流行前，p=0.8）、ICU 入院（9.6%大流行 vs. 12%大流行前，p=0.2）、死亡率（0.5%大流行 vs. 0.6%大流行前，p=0.8）或住院时间（中位数[四分位距]：4[Pastor 等人，2009；Gosain 和 Brinkman，2015][2,112,11 天大流行 vs. 5[Pastor 等人，2009；Tang 等人，2020][2,102,10 天大流行前，p=0.4）。
结论
COVID-19 大流行与美国儿童医院 HAEC 入院发生率显著降低相关。应探讨社交距离等可能的病因。
证据水平
II 级。
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