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Trends in US Pediatric Hospital Admissions in 2020 Compared With the Decade Before the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How have pediatric inpatient admission volumes changed in January to June 2020 compared with prior years?

Findings  This cross-sectional study of 5 424 688 admissions at 49 hospitals in the Pediatric Health Information Systems database used ensemble forecasting models to demonstrate differences between inpatient pediatric admissions in 2020 compared with prior years. There was a maximum 45.4% reduction in admissions in 2020, associated with a 27.7% reduction in hospital charges, with significant reductions in all examined diagnoses except for birth.

Meaning  In this study, inpatient pediatric admissions in 2020 were reduced across a heterogeneous range of diagnoses during the coronavirus disease 2019 pandemic.

Abstract

Importance  In early 2020, the United States declared a public health emergency in response to coronavirus disease 2019 (COVID-19) and implemented a variety of social distancing measures. The association between the COVID-19 pandemic and the number of pediatric admissions is unclear.

Objective  To determine the changes in patterns of pediatric admissions in 2020 compared with the prior decade.

Design, Setting, and Participants  This cross-sectional study included 49 US hospitals contributing to the Pediatric Health Information Systems database. Inpatient admissions were transformed into time-series data, and ensemble forecasting models were generated to analyze admissions across a range of diagnoses in 2020 compared with previous years. The setting was inpatient admissions. All patients discharged between January 1, 2010, and June 30, 2020, from an inpatient hospital encounter were included.

Main Outcomes and Measures  Number of hospital admissions by primary diagnosis for each encounter.

Results  Of 5 424 688 inpatient encounters among 3 372 839 patients (median [interquartile range] age, 5.1 [0.7-13.3] years; 2 823 748 [52.1%] boys; 3 171 224 [58.5%] White individuals) at 49 hospitals, 213 571 (3.9%) were between January 1, 2020, and June 30, 2020. There was a decrease in the number of admissions beginning in March 2020 compared with the period from 2010 to 2019. At the nadir, admissions in April 2020 were reduced 45.4% compared with prior years (23 798 in April 2020 compared with a median [interquartile range] of 43 550 [42 110-43 946] in April 2010-2019). Inflation-adjusted hospital charges decreased 27.7% in the second quarter of 2020 compared with prior years ($4 327 580 511 in 2020 compared with a median [interquartile range] of $5 983 142 102 [$5 762 690 022-$6 324 978 456] in 2010-2019). Seasonal patterns were evident between 2010 and 2019 for a variety of common pediatric conditions, including asthma, atrial septal defects, bronchiolitis, diabetic ketoacidosis, Kawasaki syndrome, mental health admissions, and trauma. Ensemble models were able to discern seasonal patterns in admission diagnoses and accurately predicted admission rates from July 2019 until December 2019 but not from January 2020 to June 2020. All diagnoses except for birth decreased below the model 95% CIs between January 2020 and June 2020.

Conclusions and Relevance  In this cross-sectional study, pediatric admissions to US hospitals decreased in 2020 across an array of pediatric conditions. Although some conditions may have decreased in incidence, others may represent unmet needs in pediatric care during the COVID-19 pandemic.

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Article Information

Accepted for Publication: December 21, 2020.

Published: February 12, 2021. doi:10.1001/jamanetworkopen.2020.37227

Correction: This article was corrected on March 9, 2021, to fix an error in the caption for eFigure 5 in the Supplement and on April 29, 2021, to fix an error in Figure 2D.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Pelletier JH et al. JAMA Network Open.

Corresponding Author: Christopher M. Horvat, MD, MHA, Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224 (christopher.horvat@chp.edu).

Author Contributions: Drs Pelletier and Horvat had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed the final version of the manuscript and agreed on submission.

Concept and design: Pelletier, Fuhrman, Clark, Horvat.

Acquisition, analysis, or interpretation of data: Pelletier, Rakkar, Au, Clark, Horvat.

Drafting of the manuscript: Pelletier, Rakkar, Au, Horvat.

Critical revision of the manuscript for important intellectual content: Rakkar, Au, Fuhrman, Clark, Horvat.

Statistical analysis: Pelletier, Rakkar, Horvat.

Administrative, technical, or material support: Clark.

Supervision: Au, Fuhrman, Clark, Horvat.

Conflict of Interest Disclosures: Dr Pelletier reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Rakkar reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Au reported receiving grants from the National Institute of Neurological Disorders and Stroke during the conduct of the study. Dr Horvat reported receiving grants from the National Institute of Child Health and Human Development during the conduct of the study. No other disclosures were reported.

Funding/Support: Dr Pelletier is supported by grant 5T32HD040686-20 from the National Institutes of Health. Dr Rakker is supported by grant 5T32HD040686-19 from the National Institutes of Health. Dr Au is supported by grant 5K23NS104133 from the National Institute of Neurological Disorders and Stroke. Dr Horvat is supported by grant 1K23HD099331-01A1 from National Institute of Child Health and Human Development.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Stokes  EK , Zambrano  LD , Anderson  KN ,  et al.  Coronavirus disease 2019 case surveillance—United States, January 22-May 30, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(24):759-765. doi:10.15585/mmwr.mm6924e2PubMedGoogle ScholarCrossref
2.
US Department of Defense. Coronavirus: DOD response timeline. Updated January 6, 2021. Accessed October 27, 2020. https://www.defense.gov/Explore/Spotlight/Coronavirus/DOD-Response-Timeline/
3.
Schuchat  A ; CDC COVID-19 Response Team.  Public health response to the initiation and spread of pandemic COVID-19 in the United States, February 24–April 21, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(18):551-556. doi:10.15585/mmwr.mm6918e2PubMedGoogle ScholarCrossref
4.
US Centers for Disease Control and Prevention. COVID-19 data from the National Center for Health Statistics. Published October 9, 2020. Accessed October 27, 2020. https://www.cdc.gov/nchs/covid19/index.htm
5.
Moreland  A , Herlihy  C , Tynan  MA ,  et al; CDC Public Health Law Program; CDC COVID-19 Response Team, Mitigation Policy Analysis Unit.  Timing of state and territorial COVID-19 stay-at-home orders and changes in population movement—United States, March 1–May 31, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(35):1198-1203. doi:10.15585/mmwr.mm6935a2PubMedGoogle ScholarCrossref
6.
VoPham  T , Weaver  MD , Hart  JE , Ton  M , White  E , Newcomb  PA .  Effect of social distancing on COVID-19 incidence and mortality in the US.   medRxiv. Preprint published online June 12, 2020. doi:10.1101/2020.06.10.20127589Google Scholar
7.
Gao  S , Rao  J , Kang  Y ,  et al.  Association of mobile phone location data indications of travel and stay-at-home mandates with COVID-19 infection rates in the US.   JAMA Netw Open. 2020;3(9):e2020485. doi:10.1001/jamanetworkopen.2020.20485PubMedGoogle Scholar
8.
Lyu  W , Wehby  GL .  Community use of face masks and COVID-19: evidence from a natural experiment of state mandates in the US.   Health Aff (Millwood). 2020;39(8):1419-1425. doi:10.1377/hlthaff.2020.00818PubMedGoogle ScholarCrossref
9.
US Centers for Disease Control and Prevention. CDC COVID data tracker. Updated January 7, 2021. Accessed November 3, 2020. https://covid.cdc.gov/covid-data-tracker/#demographics
10.
Wu  Z , McGoogan  JM .  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648PubMedGoogle ScholarCrossref
11.
Sheridan  GA , Nagle  M , Russell  S ,  et al.  Pediatric trauma and the COVID-19 pandemic: a 12-year comparison in a level-1 trauma center.   HSS J. 2020;16(suppl 1):1-5. doi:10.1007/s11420-020-09807-yPubMedGoogle ScholarCrossref
12.
Vásquez-Hoyos  P , Diaz-Rubio  F , Monteverde-Fernandez  N ,  et al; LARed Network.  Reduced PICU respiratory admissions during COVID-19.   Arch Dis Child. 2020;archdischild-2020-320469. doi:10.1136/archdischild-2020-320469PubMedGoogle Scholar
13.
Raitio  A , Ahonen  M , Jääskelä  M ,  et al.  Reduced number of pediatric orthopedic trauma requiring operative treatment during COVID-19 restrictions: a nationwide cohort study.   Scand J Surg. Published online October 26, 2020. doi:10.1177/1457496920968014PubMedGoogle Scholar
14.
Friedrich  F , Ongaratto  R , Scotta  MC ,  et al.  Early impact of social distancing in response to COVID-19 on hospitalizations for acute bronchiolitis in infants in Brazil.   Clin Infect Dis. 2020;ciaa1458. doi:10.1093/cid/ciaa1458PubMedGoogle Scholar
15.
Kang  JM , Lee  J , Kim  YK ,  et al.  Pediatric intensive care unit admission due to respiratory syncytial virus: retrospective multicenter study.   Pediatr Int. 2019;61(7):688-696. doi:10.1111/ped.13893PubMedGoogle ScholarCrossref
16.
D’Souza  RM , Bambrick  HJ , Kjellstrom  TE , Kelsall  LM , Guest  CS , Hanigan  I .  Seasonal variation in acute hospital admissions and emergency room presentations among children in the Australian Capital Territory.   J Paediatr Child Health. 2007;43(5):359-365. doi:10.1111/j.1440-1754.2007.01080.xPubMedGoogle ScholarCrossref
17.
Hirsch  AW , Monuteaux  MC , Fruchtman  G , Bachur  RG , Neuman  MI .  Characteristics of children hospitalized with aspiration pneumonia.   Hosp Pediatr. 2016;6(11):659-666. doi:10.1542/hpeds.2016-0064PubMedGoogle ScholarCrossref
18.
Burns  JC , Herzog  L , Fabri  O ,  et al; Kawasaki Disease Global Climate Consortium.  Seasonality of Kawasaki disease: a global perspective.   PLoS One. 2013;8(9):e74529. doi:10.1371/journal.pone.0074529PubMedGoogle Scholar
19.
Xirasagar  S , Lin  HC , Liu  TC .  Seasonality in pediatric asthma admissions: the role of climate and environmental factors.   Eur J Pediatr. 2006;165(11):747-752. doi:10.1007/s00431-006-0164-6PubMedGoogle ScholarCrossref
20.
Grech  V , Balzan  M , Asciak  RP , Buhagiar  A .  Seasonal variations in hospital admissions for asthma in Malta.   J Asthma. 2002;39(3):263-268. doi:10.1081/JAS-120002476PubMedGoogle ScholarCrossref
21.
Ramgopal  S , Dunnick  J , Siripong  N , Conti  KA , Gaines  BA , Zuckerbraun  NS .  Seasonal, weather, and temporal factors in the prediction of admission to a pediatric trauma center.   World J Surg. 2019;43(9):2211-2217. doi:10.1007/s00268-019-05029-4PubMedGoogle ScholarCrossref
23.
Handley  SC , Mullin  AM , Elovitz  MA ,  et al.  Changes in preterm birth phenotypes and stillbirth at 2 Philadelphia hospitals during the SARS-CoV-2 pandemic, March-June 2020.   JAMA. 2020. doi:10.1001/jama.2020.20991PubMedGoogle Scholar
24.
Stowe  J , Smith  H , Thurland  K , Ramsay  ME , Andrews  N , Ladhani  SN .  Stillbirths during the COVID-19 pandemic in England, April-June 2020.   JAMA. 2020. doi:10.1001/jama.2020.21369PubMedGoogle Scholar
25.
Mongelluzzo  J , Mohamad  Z , Ten Have  TR , Shah  SS .  Corticosteroids and mortality in children with bacterial meningitis.   JAMA. 2008;299(17):2048-2055. doi:10.1001/jama.299.17.2048PubMedGoogle ScholarCrossref
26.
Enhancing the Quality and Transparency of Health Research. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Accessed December 13, 2020. https://www.equator-network.org/reporting-guidelines/strobe/
27.
Feudtner  C , Feinstein  JA , Zhong  W , Hall  M , Dai  D .  Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.   BMC Pediatr. 2014;14:199. doi:10.1186/1471-2431-14-199PubMedGoogle ScholarCrossref
28.
Dunn  A , Grosse  SD , Zuvekas  SH .  Adjusting health expenditures for inflation: a review of measures for health services research in the United States.   Health Serv Res. 2018;53(1):175-196. doi:10.1111/1475-6773.12612PubMedGoogle ScholarCrossref
29.
Webel  K , Ollech  D . Condensing information from multiple seasonality tests with random forests. Paper presented at: Proceedings of the 61st ISI World Statistics Congress 2017; July 16-21, 2017; Marrakech, Morocco.
30.
Sato  RC .  Disease management with ARIMA model in time series.   Einstein (Sao Paulo). 2013;11(1):128-131. doi:10.1590/S1679-45082013000100024PubMedGoogle ScholarCrossref
31.
Patel  JL , Goyal  RK .  Applications of artificial neural networks in medical science.   Curr Clin Pharmacol. 2007;2(3):217-226. doi:10.2174/157488407781668811PubMedGoogle ScholarCrossref
32.
Zhang  Z , Zhang  H , Khanal  MK .  Development of scoring system for risk stratification in clinical medicine: a step-by-step tutorial.   Ann Transl Med. 2017;5(21):436. doi:10.21037/atm.2017.08.22PubMedGoogle ScholarCrossref
33.
Hyndman  RJ , Athanasopoulos  G . Forecasting: Principles and Practice. 2nd ed. OTexts; 2018.
34.
Grolemund  G , Wickham  H.   R for Data Science. O’Reilly; 2017.
35.
Pediatric seasonality. Accessed January 7, 2021. https://github.com/drjonpelly/pediatric_seasonality/
36.
Jackson  CC , Albanese-O’Neill  A , Butler  KL ,  et al.  Diabetes care in the school setting: a position statement of the American Diabetes Association.   Diabetes Care. 2015;38(10):1958-1963. doi:10.2337/dc15-1418PubMedGoogle ScholarCrossref
37.
American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis.  Diagnosis and management of bronchiolitis.   Pediatrics. 2006;118(4):1774-1793. doi:10.1542/peds.2006-2223PubMedGoogle ScholarCrossref
38.
Dougherty  RH , Fahy  JV .  Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype.   Clin Exp Allergy. 2009;39(2):193-202. doi:10.1111/j.1365-2222.2008.03157.xPubMedGoogle ScholarCrossref
39.
US Centers for Disease Control and Prevention. Pneumococcal disease. Published November 21, 2019. Accessed October 28, 2020. https://www.cdc.gov/pneumococcal/clinicians/streptococcus-pneumoniae.html
40.
Yeoh  DK , Foley  DA , Minney-Smith  CA ,  et al.  The impact of COVID-19 public health measures on detections of influenza and respiratory syncytial virus in children during the 2020 Australian winter.   Clin Infect Dis. 2020;ciaa1475. doi:10.1093/cid/ciaa1475PubMedGoogle Scholar
41.
Weiss  AJ , Elixhauser  A . Statistical brief #207: sports-related emergency department visits and hospital inpatient stays, 2013. Healthcare Cost and Utilization Project. Updated August 9, 2016. Accessed October 28, 2020. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb207-Sports-Hospital-Emergency-Department-2013.jsp
42.
Moore  SA , Faulkner  G , Rhodes  RE ,  et al.  Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey.   Int J Behav Nutr Phys Act. 2020;17(1):85. doi:10.1186/s12966-020-00987-8PubMedGoogle ScholarCrossref
43.
Salari  N , Hosseinian-Far  A , Jalali  R ,  et al.  Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis.   Global Health. 2020;16(1):57. doi:10.1186/s12992-020-00589-wPubMedGoogle ScholarCrossref
44.
Guessoum  SB , Lachal  J , Radjack  R ,  et al.  Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown.   Psychiatry Res. 2020;291:113264. doi:10.1016/j.psychres.2020.113264PubMedGoogle Scholar
45.
Moreno  C , Wykes  T , Galderisi  S ,  et al.  How mental health care should change as a consequence of the COVID-19 pandemic.   Lancet Psychiatry. 2020;7(9):813-824. doi:10.1016/S2215-0366(20)30307-2PubMedGoogle ScholarCrossref
46.
Kadambari  S , Abo  YN , Phuong  LK , Osowicki  J , Bryant  PA .  Decrease in infection-related hospital admissions during COVID-19: why are parents avoiding the doctor?   Pediatr Infect Dis J. 2020;39(11):e385-e386. doi:10.1097/INF.0000000000002870PubMedGoogle ScholarCrossref
47.
Lazzerini  M , Barbi  E , Apicella  A , Marchetti  F , Cardinale  F , Trobia  G .  Delayed access or provision of care in Italy resulting from fear of COVID-19.   Lancet Child Adolesc Health. 2020;4(5):e10-e11. doi:10.1016/S2352-4642(20)30108-5PubMedGoogle ScholarCrossref
48.
Orthopoulos  G , Santone  E , Izzo  F ,  et al.  Increasing incidence of complicated appendicitis during COVID-19 pandemic.   Am J Surg. 2020;S0002-9610(20)30595-X. doi:10.1016/j.amjsurg.2020.09.026PubMedGoogle Scholar
49.
Dawson  KL , Vincent  LL , Krieger  EV , Stout  KK , Buber  J .  Acute increase in deaths among patients with adult congenital heart disease during COVID-19: single-center experience.   JACC Case Rep. 2020;2(9):1275-1278. doi:10.1016/j.jaccas.2020.06.013PubMedGoogle ScholarCrossref
50.
Khullar  D , Bond  AM , Schpero  WL .  COVID-19 and the financial health of US hospitals.   JAMA. 2020;323(21):2127-2128. doi:10.1001/jama.2020.6269PubMedGoogle ScholarCrossref
51.
Park  R , Her  M , Shapiro  M , Holloran  K . 2019 Median ratios for not-for-profit children’s hospitals. FitchRatings. Published July 22, 2019. Accessed November 1, 2020. https://californiahealthline.org/wp-content/uploads/sites/3/2020/05/Fitch-2019-Median-Ratios-for-Not-for-Profit-Childrens-Hospitals-2019-07-22-1.pdf
52.
Burdick  H , Pino  E , Gabel-Comeau  D ,  et al.  Validation of a machine learning algorithm for early severe sepsis prediction: a retrospective study predicting severe sepsis up to 48 h in advance using a diverse dataset from 461 US hospitals.   BMC Med Inform Decis Mak. 2020;20(1):276. doi:10.1186/s12911-020-01284-xPubMedGoogle ScholarCrossref
53.
Kim  HJ , Han  D , Kim  JH ,  et al.  An easy-to-use machine learning model predicting prognosis of patients with COVID-19: retrospective cohort study.   J Med internet Res. 2020;22(11):e24225. doi:10.2196/24225PubMedGoogle Scholar
54.
Morgenstern  JD , Buajitti  E , O’Neill  M ,  et al.  Predicting population health with machine learning: a scoping review.   BMJ Open. 2020;10(10):e037860. doi:10.1136/bmjopen-2020-037860PubMedGoogle Scholar
55.
Talpur  BA , O’Sullivan  D .  Cyberbullying severity detection: a machine learning approach.   PLoS One. 2020;15(10):e0240924. doi:10.1371/journal.pone.0240924PubMedGoogle Scholar
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