Trends in Disease Severity Among Critically Ill Children With Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Multicenter Cohort Study in the United States

Authors

• Catherine E. Ross, Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
• Jeffrey P. Burns, Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
• Anne V. Grossestreuer, Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
• Pallav Bhattarai, Division of Pediatric Critical Care, Department of Pediatrics, Baystate Children's Hospital, UMass Chan Medical School Baystate, Springfield, MA.
• Christine A. McKiernan, Division of Pediatric Critical Care, Department of Pediatrics, Baystate Children's Hospital, UMass Chan Medical School Baystate, Springfield, MA.
• Jennifer D. Franks, Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
• Sonja Lehmann, Emory University School of Medicine, Atlanta, GA.
• Jill L. Sorcher, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
• Matthew P. Sharron, Division of Critical Care Medicine, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
• Kitman Wai, Division of Critical Care Medicine, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
• Haitham Al-Wahab, Division of Critical Care Medicine, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, TX.
• Konstantinos Boukas, Division of Critical Care Medicine, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, TX.
• Mark W. Hall, Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
• George Ru, Division of Pediatric Critical Care and Hospitalist Medicine, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY.
• Anita I. Sen, Division of Pediatric Critical Care and Hospitalist Medicine, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY.
• Hariprem R. Rajasekhar, Division of Pediatric Critical Care, Department of Pediatrics, Bristol-Myers Squibb Children's Hospital, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
• Lawrence C. Kleinman, Division of Population Health, Quality, and Implementation Science, Department of Pediatrics, Bristol-Myers Squibb Children's Hospital, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
• John K. McGuire, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
• Amy S. Arrington, Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
• Flor Munoz-Rivas, Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
• Christopher M. Osborne, Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
• Lara S. Shekerdemian, Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Volume

24

Issue

1

DOI

10.1097/PCC.0000000000003105

Abstract

OBJECTIVES: To describe trends in critical illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children over the course of the COVID-19 pandemic. We hypothesized that PICU admission rates were higher in the Omicron period compared with the original outbreak but that fewer patients needed endotracheal intubation. DESIGN: Retrospective cohort study. SETTING: This study took place in nine U.S. PICUs over 3 weeks in January 2022 (Omicron period) compared with 3 weeks in March 2020 (original period). PATIENTS: Patients less than or equal to 21 years old who screened positive for SARS-CoV-2 infection by polymerase chain reaction or hospital-based rapid antigen test and were admitted to a PICU or intermediate care unit were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 267 patients (239 Omicron and 28 original) were reviewed. Forty-five patients in the Omicron cohort had incidental SARS-CoV-2 and were excluded from analysis. The Omicron cohort patients were younger compared with the original cohort patients (median [interquartile range], 6 yr [1.3-13.3 yr] vs 14 yr [8.3-17.3 yr]; p = 0.001). The Omicron period, compared with the original period, was associated with an average increase in COVID-19-related PICU admissions of 13 patients per institution (95% CI, 6-36; p = 0.008), which represents a seven-fold increase in the absolute number admissions. We failed to identify an association between cohort period (Omicron vs original) and odds of intubation (odds ratio, 0.7; 95% CI, 0.3-1.7). However, we cannot exclude the possibility of up to 70% reduction in intubation. CONCLUSIONS: COVID-19-related PICU admissions were seven times higher in the Omicron wave compared with the original outbreak. We could not exclude the possibility of up to 70% reduction in use of intubation in the Omicron versus original epoch, which may represent differences in PICU/hospital admission policy in the later period, or pattern of disease, or possibly the impact of vaccination.

APA Citation

Ross, Catherine E.; Burns, Jeffrey P.; Grossestreuer, Anne V.; Bhattarai, Pallav; McKiernan, Christine A.; Franks, Jennifer D.; Lehmann, Sonja; Sorcher, Jill L.; Sharron, Matthew P.; Wai, Kitman; Al-Wahab, Haitham; Boukas, Konstantinos; Hall, Mark W.; Ru, George; Sen, Anita I.; Rajasekhar, Hariprem R.; Kleinman, Lawrence C.; McGuire, John K.; Arrington, Amy S.; Munoz-Rivas, Flor; Osborne, Christopher M.; and Shekerdemian, Lara S., "Trends in Disease Severity Among Critically Ill Children With Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Multicenter Cohort Study in the United States" (2023). GW Authored Works. Paper 2333.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2333

Department

Pediatrics