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

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.

Department

Pediatrics

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