Multicenter Study of the Impact of COVID-19 Shelter-In-Place on Tertiary Hospital-based Care for Pediatric Neurologic Disease

Melissa L. Hutchinson, Department of Pediatrics, Neurology Division, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Kendall B. Nash, Departments of Neurology and Pediatrics, Division of Child Neurology, University of California, San Francisco, Benioff Children's Hospital San Francisco, San Francisco, CA, USA.
Nicholas S. Abend, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia PA, USA.
Mahendranath Moharir, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada.
Elizabeth Wells, Center for Neuroscience and Behavioral Medicine, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Ricka D. Messer, Department of Pediatrics, Section of Child Neurology, University of Colorado, Aurora, CO, USA.
Jamie Palaganas, Department of Pediatrics, Division of Child Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
Ingo Helbig, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia PA, USA.
Sharon O. Wietstock, The Epilepsy NeuroGenetics Initiative (ENGIN), Department of Biomedical and Health Informatics (DBHi), Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
William Suslovic, Department of Neurology, Children's National Hospital, Washington, DC, USA.
Alexander K. Gonzalez, The Epilepsy NeuroGenetics Initiative (ENGIN). Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia PA, USA 1.
Michael C. Kaufman, The Epilepsy NeuroGenetics Initiative (ENGIN). Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia PA, USA 1.
Craig A. Press, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia PA, USA.
Juan Piantino, Department of Pediatrics, Section of Child Neurology, Oregon Health & Science University, Portland, OR, USA.

Document Type

Journal Article

Publication Date

4-1-2022

Journal

The Neurohospitalist

Volume

12

Issue

2

DOI

10.1177/19418744211063075

Keywords

COVID-19; coronavirus; neurology; pediatric; shelter-in-place

Abstract

Objective: To describe changes in hospital-based care for children with neurologic diagnoses during the initial 6 weeks following regional Coronavirus 2019 Shelter-in-Place orders. Methods: This retrospective cross-sectional study of 7 US and Canadian pediatric tertiary care institutions included emergency and inpatient encounters with a neurologic primary discharge diagnosis code in the initial 6 weeks of Shelter-in-Place (COVID-SiP), compared to the same period during the prior 3 years (Pre-COVID). Patient demographics, encounter length, and neuroimaging and electroencephalography use were extracted from the medical record. Results: 27,900 encounters over 4 years were included. Compared to Pre-COVID, there was a 54% reduction in encounters during Shelter-in-Place. COVID-SiP patients were younger (median 5 years vs 7 years). The incidence of encounters for migraine fell by 72%, and encounters for acute diagnoses of status epilepticus, infantile spasms, and traumatic brain injury dropped by 53%, 55%, and 56%, respectively. There was an increase in hospital length of stay, relative utilization of intensive care, and diagnostic testing (long-term electroencephalography, brain MRI, and head CT (all <.01)). Conclusion: During the initial 6 weeks of SiP, there was a significant decrease in neurologic hospital-based encounters. Those admitted required a high level of care. Hospital-based neurologic services are needed to care for acutely ill patients. Precise factors causing these shifts are unknown and raise concern for changes in care seeking of patients with serious neurologic conditions. Impacts of potentially delayed diagnosis or treatment require further investigation.

Department

Neurology

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