Background Children have been less impacted by the Coronavirus disease 19 (COVID) pandemic, but its repercussions on pediatric illnesses may have been significant. We examined the indirect impact of the pandemic on a population of critically ill children in the United States. Research Question Were there significantly fewer critically ill children admitted to PICUs during the 2 nd quarter of 2020, and were there significant changes in the types of diseases admitted? Study Design and Methods Retrospective observational cohort study using the Virtual Pediatric Systems (VPS, LLC) database. Participants were 160,295 children admitted to the Pediatric Intensive Care Unit (PICU) at 77 sites in the United States during quarters 1 (Q1) and 2 (Q2) of 2017-2019 (pre-COVID) and 2020 (COVID). Results The average number of admissions was similar between pre-COVID Q1 and COVID Q1, but decreased by 32% from pre-COVID Q2 to COVID Q2 (20,157 to 13,627 admissions/quarter). The largest decreases were in respiratory conditions, including asthma (1,327 subjects in pre-COVID Q2 [6.6% of patients] vs 241 subjects in COVID Q2 [1.8%]; p<0.001) and bronchiolitis (1,299 [6.5%] vs 121 [0.9%]; p<0.001). The percentage of trauma admissions increased, though the raw number of trauma admissions decreased. Admissions for diabetes mellitus and poisoning/ingestion also increased. In the multivariable model, illness severity-adjusted odds of ICU mortality for PICU patients during COVID Q2 increased compared to pre-COVID Q2 [OR 1.165; 95% CI 1.00, 1.357; p=0.049]. Interpretation Pediatric critical illness admissions decreased substantially during the 2 nd quarter of 2020, with significant changes in the types of diseases seen in PICUs in the United States. There was an increase in mortality in children admitted to the PICU during this period.

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MEASUREMENTS AND MAIN RESULTS:Diagnosis categories were determined for all 110,418 patients admitted during the 20-week study period in each year (2018, 2019, and 2020). Admission data were normalized relative to statewide school closure dates for each patient using geographic data. The "before school closure" epoch was defined as 8 weeks prior to school closure, and the "after school closure" epoch was defined as 12 weeks following school closure. For each diagnosis, admission ratios for each study day were calculated by dividing 2020 admissions by 2018-2019 admissions. The 10 most common diagnosis categories were examined. Significant changes in admission ratios were identified for bronchiolitis, pneumonia, and asthma. These changes occurred at 2, 8, and 35 days following school closure, respectively. PICU admissions decreased by 82% for bronchiolitis, 76% for pneumonia, and 76% for asthma. Nonrespiratory diseases such as diabetic ketoacidosis, status epilepticus, traumatic injury, and poisoning/ingestion did not show significant changes following school closure. CONCLUSIONS:School closures are associated with a dramatic reduction in the prevalence of severe respiratory disease requiring PICU admission. School closure may be an effective tool to mitigate future pandemics but should be balanced with potential academic, economic, mental health, and social consequences.

To characterize the epidemiology of children and adolescents admitted for deliberate self-harm to PICUs in the United States by examining patient demographics, diagnoses, modes of self-harm, and outcomes.DESIGN: Descriptive analysis of a large, multicenter, quality-controlled database. SETTING:The 137 PICUs participating in the Virtual Pediatric Systems database during the study period.

This cohort study compares the epidemiology and outcomes of patients in the pediatric intensive care unit with SARS-CoV-2–related disease during the first 15 months of the COVID-19 pandemic vs children with critical influenza prior to the pandemic.