Pediatric Intensive Care Unit Admissions for COVID-19: Insights Using State-Level Data

  1. Rohit S. Loomba
  2. Enrique G. Villarreal
  3. Juan S. Farias
  4. Ronald A. Bronicki
  5. Saul Flores

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Abstract

Introduction. Intensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care units (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions. Materials and Methods. This is a retrospective cohort study using data from the COVID-19 Virtual Pediatric System (VPS) dashboard containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state-level data contained 13 different factors from population density, comorbid conditions, and social distancing score. The absolute CPA count was converted to frequency using the state’s population. Univariate and multivariate regression analyses were performed to assess the association between CPA frequency and admission endpoints. Results. A total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPA frequency was 2.8 per million children in a one-month period. A total of 3,235 tests were conducted of which 6.3% were positive. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days (1.25–12.00 days). Out of the 1,132 total CPA days, 592 (52.2%) involved mechanical ventilation. The inpatient mortalities were 3 (1.4%). Multivariate analyses demonstrated an association between CPAs with greater population density (beta coefficient 0.01, p < 0.01 ). Multivariate analyses also demonstrated an association between pediatric type 1 diabetes mellitus with increased CPA duration requiring advanced respiratory support (beta coefficient 5.1, p < 0.01 ) and intubation (beta coefficient 4.6, p < 0.01 ). Conclusions. Inpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density. Type 1 DM appears to be associated with increased duration of HFNC and intubation. These factors should be included in future studies using patient-level data.

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  1. Version published to 10.1155/2020/9680905
  2. ScreenIT

    SciScore for 10.1101/2020.07.22.20160226: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: As such, no institutional review board review or approval was sought.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were done using the user-coded, syntax-based interface of SPSS Version 23.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    While these analyses offer novel data regarding CPAs in the US, they are not without their limitations. Firstly, all the data is state-wide data as no patient-level data was used. Thus, the 48 states with reported data are the cases, not the 205 individual CPAs. The data regarding comorbidities, environmental factors, and socioeconomic factors is also state-level data and is not specific to the CPAs. Rather, the information used is publicly available data about the children or families in the respective state. Additionally, the multivariate analyses are underpowered and thus the univariate analyses in this study offer the more meaningful data. It must be kept in mind that all significant findings in this study are simply associations as causation cannot be inferred due to the study design. Thus, findings such as those related to immunizations and social distancing, cannot be considered to be causal and should not be utilized to impact decision-making. Despite the limitations outlined, these analyses offer helpful information that may be used to assist during the consideration as to what factors need more clarification from future studies with patient-level data. These results also offer a cross-sectional view regarding US PICU CPAs not previously reported. The use of state-level data allowed for analyses relatively early, before aggregate, multicenter, patient-level data-based studies can be completed, thus, it can used while the pandemic is still occurring. Furthermore, thes...

    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.

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  3. Version published to 10.1101/2020.07.22.20160226v1 on medRxiv