Characteristics of initial hospitalization and readmissions among pediatric patients with COVID-19 in the US

Although coronavirus disease 2019 (COVID-19)-related hospitalization rates in children and adolescents are lower than in adults, COVID-19 can cause significant disease in children and adolescents and lead to substantial long-term problems. According to previous studies conducted in the United States (US), 10-33% of children and adolescents with COVID-19-related hospitalizations were admitted to an intensive care unit (ICU), up to 10% required invasive mechanical ventilation (IMV), and up to 2% died, depending on the periods of assessment.

Study: COVID-19-Associated Hospitalizations Among Children Less Than 12 Years of Age in the United States. Image Credit: SweetLeMontea/ShutterstockStudy: COVID-19-Associated Hospitalizations Among Children Less Than 12 Years of Age in the United States. Image Credit: SweetLeMontea/Shutterstock

COVID-19 hospitalizations among children and adolescents aged 0-17 years increased significantly in the latter weeks of July and August 2021, according to two studies conducted by the Centers for Disease Control and Prevention (CDC), with periods extending into when the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant was circulating in the United States. More comprehensive data on health outcomes and the hospital cost burden of pediatric COVID-19-associated hospitalizations among different pediatric age groups is necessary with the reopening of schools and the preponderance of the delta variant in the US from mid-July to December 2021.

Furthermore, the scientific literature lacks information on the readmission outcomes of pediatric populations with COVID-19-related hospitalizations. The Pfizer-BioNTech COVID-19 vaccine received emergency use authorization in the United States on October 29, 2021, for children aged five to 11. The phase 2/3 trial will provide more safety and efficacy data in children aged six months to five years.

Decision-makers may find specific data on health outcomes and the hospital economic burden of pediatric COVID-19 patients relevant as they plan policy implementations and future investments in COVID-19 prevention and treatment for children. In this study, a team of researchers from various institutions describe the characteristics, costs, and healthcare resource use associated with pediatric COVID-19 patients.

A preprint version of this study, which is yet to undergo peer review, is available on the medRxiv* server.

The study

Within two months, 96 pediatric patients were readmitted to the hospital for COVID-19; 61.5% of those readmitted were aged 0-4 years, while 38.5% were aged 5-11 years. The average age of readmitted pediatric cases was 4.1 years; it was 1.3 years in the 0-4 year age group and 8.5 years in the 5-11 year age group.

Immunocompromised conditions were more common among readmitted children than those who had index hospitalizations: 47.9% among children aged 0-11 years, 42.4% among children aged 0-4 years, and 56.8% among children aged 5-11 years. Approximately 85% of all COVID-19-related readmissions occurred within one month; the 96 COVID-19-related readmissions accounted for roughly one-third of the pediatric cohort's all-cause readmissions.

The majority of pediatric patients (76.1%) were admitted to the general ward without receiving ICU or invasive mechanical ventilation (IMV), 16.6% were admitted to the ICU but did not receive IMV, 0.7% were admitted to the ICU but did not receive IMV, and 6.6% were admitted to the ICU and received IMV. In all, 23.1% of patients were admitted to the ICU, with 7.3% receiving IMV. The average length of stay (LOS) in the hospital was 4.3 days, up from 2.9 days in the general ward to 17.0 days for those admitted to the ICU with IMV use. In-hospital mortality climbed from zero in the general ward to 7.0% among patients admitted to the ICU and using IMVs.

The average cost and charge were $14,760 and $58,418. Eighty-three percent of the pediatric research participants had non-zero hospital charges. The mean (median) charge to cost ratio among those having validated hospital cost data was determined as 4.0 based on the mean expenses and charges recorded. The cost of hospitalization increased as the condition progressed; for example, the median cost in the general ward was $4,913, while it was $43,279 for those admitted to the ICU with IMV use.

From April 2020 to April 2021, 64.2% of pediatric COVID-19-associated hospital admissions occurred before, 5.1% during, and 30.7% during the delta variant predominance. Pediatric COVID-19-associated hospitalizations increased from 6.7% 2020 to 8.7% in December 2020 to 9.8% in January 2021, then declined until June 2021, then increased again in the months of delta predominance: July 2021 (5.6%), August 2021 (13.6%), and September 2021 (11.5%). Across the study periods, the percentage of pediatric patients in ICUs and using IMVs were similar. Pre-delta readmissions were 2.4%, transition readmissions were 1.7%, and delta readmissions were 1.6%.

Implications

As of December 2, 2021, there were 7,032,612 pediatric cases of COVID-19 illness in the United States, and as of December 5, 2021, only about 17% of children aged 5 to 11 had received at least one COVID-19 vaccine dose, representing nearly 4.8 million children out of a total population of 28 million. As a result, vaccine implementation in this age range has been delayed, possibly due to parental apprehension. With these considerations in mind, the outcomes of this study highlight the necessity of COVID-19 immunization for the pediatric population, which accounts for 22.2% of the general population in the United States.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Colin Lightfoot

Written by

Colin Lightfoot

Colin graduated from the University of Chester with a B.Sc. in Biomedical Science in 2020. Since completing his undergraduate degree, he worked for NHS England as an Associate Practitioner, responsible for testing inpatients for COVID-19 on admission.

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