Comparing health care use after hospital visit for SARS-CoV-2, respiratory syncytial virus, and other respiratory tract infections in children

  1. Vilde Bergstad Larsen
  2. Ketil Størdal
  3. Kjetil Telle
  4. Fredrik Methi
  5. Karin Magnusson

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Abstract

Aim

To explore whether children in specialist care with COVID-19 have increased post-discharge health care use when compared to children in specialist care with 1) respiratory syncytial virus (RSV) infection, and 2) other respiratory tract infections (RTIs).

Methods

In 34,214 children aged 1 month to 5 years who were registered with one or more hospital visit (outpatient or inpatient) with a diagnosis of COVID-19 (N=128), RSV infection (N=4,009), or other RTIs (N=34,458) from 2017-2021, we used a difference-in-differences study design to investigate the individual all-cause primary and specialist health care use from 12 weeks prior to 12 weeks after the hospital visit, stratified on infants (1-12 months) and children (1-5 years).

Results

We found a slight increase in primary health care use in the first four weeks after the hospital visit for infants with COVID-19 when compared to infants with RSV infection (6 [95%CI=2 to 13] per 10,000, 0.52% relative increase). For infants diagnosed with COVID-19, we found a similar post-visit increase in inpatients when compared to infants with RSV infection, which lasted for 12 weeks.

Conclusions

Our findings imply slightly increased health care use among infants after hospital visit for COVID-19 than among infants with other respiratory tract infections, for which potential etiological mechanisms deserve future clinical research. Severe COVID-19 in young children will not represent any markedly increased burden on the health services.

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  1. Version published to 10.1101/2021.11.22.21266522v2 on medRxiv
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    SciScore for 10.1101/2021.11.22.21266522: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Institutional board review was conducted, and The Ethics Committee of South-East Norway confirmed (June 4th, 2020, #153204) that external ethical board review was not required.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: An important strength of our study is the utilization of routinely collected individual-level data from nation-wide registers that are mandated by law, ensuring representativeness and no attrition. Relatedly, our use of two comparison groups (RSV infection and other RTIs) as well as several post-discharge time periods strengthens the robustness of our findings. Some limitations to our data and results should be noted. First, severe COVID-19 requiring hospitalization is extremely rare in children, which is reflected in the sample size and statistical strength even in our nation-wide population. Along this line, due to the suppressed incidence of hospitalizations for RSV and other RTI because of disease control measures during 2020 and 2021, we had to compare the incidence of the very few hospitalizations for COVID-19 during these years, with the much higher incidence of RSV infection and other RTI hospitalizations during 2017-2019. This was handled by the inclusion of seasonal variations (calendar month and year) in our models. A second limitation may be that for children in most age and diagnosis groups, we found similar utilization levels for specialist health care as for primary health care in the weeks prior to hospital admission. This may indicate that children who need hospitalization due to the included diseases generally have poorer health and thus different patterns of health-seeking behavior than the general population. Thus, hospitalizatio...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.11.22.21266522v1 on medRxiv