Impact of the COVID-19 pandemic on hospitalizations of children with neurologic impairment

Abstract

Introduction: Children with neurologic impairment (NI) are frequently hospitalized for infectious and noninfectious illnesses. The early period of the COVID-19 pandemic was associated with overall lower pediatric hospitalization rates, particularly for respiratory infections, but the effect on utilization for children with NI is unknown.

Method: This multicenter retrospective cohort study included hospitalizations of children 1-18 years of age with NI diagnosis codes from 49 children's hospitals. We calculated the percent change in the median weekly hospitalization volumes and the hospitalization resource intensity score (H-RISK), comparing the early-COVID era (March 15, 2020 to December 31, 2020) with the pre-COVID era (same timeframe of 2017-2019). Percent change was calculated over the entire study period as well as within three seasonal time periods (spring, summer, and fall/winter). Differences between infectious and noninfectious admission diagnoses were also examined.

Results: Compared with the pre-COVID era, there was a 14.4% decrease (interquartile range [IQR]: -33.8, -11.7) in the weekly median number of hospitalizations in the early-COVID era; the weekly median H-RISK score was 11.7% greater (IQR: 8.9, 14.9). Hospitalizations decreased for both noninfectious (-11.6%, IQR: -30.0, -8.0) and infectious (-35.5%, IQR: -51.1, -31.3) illnesses in the early-COVID era. This decrease was the largest in spring 2020 and continued throughout 2020.

Conclusions: For children with NI, there was a substantial and significant decrease in hospitalizations for infectious and noninfectious diagnoses but an increase in illness severity during the early-COVID era compared with the pre-COVID era. Our data suggest a need to reconsider current thresholds for hospitalization and identify opportunities to support and guide families through certain illnesses without hospitalization.

Figure 1

Weekly hospitalizations of children with neurologic impairment in the pre‐COVID and early‐COVID eras. Trends in weekly hospitalizations over time are shown for (a) all diagnoses, (b) noninfectious illnesses, and (c) infectious illnesses. The gray lines represent the median volume between 2017 and 2019, while the black lines represent hospitalization numbers from 2020. Data from January 1 to March 15 are included in these figures to demonstrate the initial 2020 trend of hospitalizations prior to the beginning of the early‐COVID era; the vertical dashed line denotes the week of March 15th in 2020 to highlight the beginning of the early‐COVID era. Note that Y axes are different in panel figures to allow for improved visualization of data.

Figure 2

Weekly H‐RISK case mix of hospitalizations for children with neurologic impairment in the pre‐COVID and early‐COVID eras. Trends in the weekly median hospitalization resource intensity scores for kids (H‐RISK) case mix over time are shown for (a) all diagnoses, (b) noninfectious illnesses, and (c) infectious illnesses. The gray lines represent the median weekly H‐RISK between 2017 and 2019, while the black lines represent median weekly H‐RISK from 2020. Data from January 1 to March 15 are included in these figures to demonstrate the initial 2020 trend prior to the beginning of the early‐COVID era; the vertical dashed line denotes the week of March 15th in 2020 to highlight the beginning of the early‐COVID era.