Non-COVID kids' hospital cases nearly halved early in pandemic

US pediatric non–COVID-19 hospitalizations fell up to 45.4% amid the pandemic and related lockdowns compared with previous years, a study published late last week in JAMA Network Open finds.

Children's Hospital of Philadelphia researchers conducted a retrospective analysis of the Pediatric Health Information Systems database of 5,424,688 admissions of 3,372,839 children to 49 hospitals from Jan 1, 2010, to Jun 30, 2020.

Of the 5,424,688 hospitalizations, 213,571 (3.9%) occurred from Jan 1 to Jun 30, 2020. Admissions began dropping in March 2020, reaching a 45.4% reduction in April over previous years for all diagnoses except birth. Hospitalizations increased in May and June but were still less than those of previous years.

As a result, inflation-adjusted hospital charges fell 3.3% from those of the previous decade in the first 3 months of 2020, tumbling to a 27.7% reduction in the second quarter (median, $4.3 billion vs $6.0 billion).

Fewer respiratory failure admissions

Unlike in 2020, hospitalizations for common pediatric conditions such as asthma, atrial septal defects, bronchiolitis, diabetic ketoacidosis, Kawasaki disease, mental illness, and trauma followed seasonal patterns from 2010 to 2019, with significantly fewer children hospitalized, admitted to intensive care units, or needing mechanical ventilation in the summer rather than the winter.

In April 2020, admissions for winter-associated bronchiolitis and bacterial pneumonia began falling earlier than expected, at the same time as hospitalizations for all-cause acute respiratory failure dropped off.

"Given the infectious nature of these conditions and their spread by respiratory droplets, this may have been associated with the effects of social distancing and possibly was even fortunate, given evidence of a potentially severe respiratory virus season in 2019 to 2020, with the highest number of respiratory failure admissions recorded in the past decade," the authors said.

Average length of hospital stay throughout the study period was 3 days, although 3.4% of patients stayed 30 days or longer. Survival to hospital release was 99.2%; in-hospital death rates didn't change significantly from 2010 to 2019, with exploratory analyses showing lower-than-expected numbers starting in March 2020. Of all patients, 54.9% were covered by government insurance, and 45.7% had an underlying complex chronic illness.

Rates may not reflect true incidence, care needs

The researchers said that the changes in hospitalization rates could have been due to reductions in illness incidence, a reluctance to seek medical care because of fear of infection, or unaddressed care needs. For example, decreases in admission rates for repair of congenital heart defects could be caused by either deferral or underrecognition because of fewer pediatric healthcare visits.

"Taken together, these findings are worrisome, although not definitive, in that unmet health care needs may be accumulating in the pediatric population as a result of decreased health care interactions," the authors wrote.

Reduced hospitalizations also have a financial impact on children's hospitals, although they typically have superior operating margins than other nonprofit hospitals, they said: "Leaders of children's hospitals could face unique challenges in the coming months as patient volumes eventually recover and are potentially coupled with the destabilizing financial effects of the COVID-19 pandemic."

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