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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.


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 (

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.

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