Ramesh Sachdeva, BS, MB, FCCM (he/him/his)
Children's Hospital of Michigan
Detroit, MI
Disclosure information not submitted.
Gerardo Soto-Campos, MS, PhD
Director of Analytics
Virtual Pediatric Systems, LLC, United States
Disclosure information not submitted.
Nancy Brundage, MPH, BSN, RN,
Senior Director of Clinical Affairs
Virtual Pediatric Systems
Los Angeles, California
Disclosure information not submitted.
Tom Rice, BS, MD
Professor, Pediatrics (Emeritus)
Medical College of Wisconsin, United States
Disclosure information not submitted.
Randall Wetzel, BS, MB, MBA, FCCM
Professor of Anesthesiology and Pediatrics
Children's Hospital of Los Angeles
Los Angeles, California, United States
Disclosure information not submitted.
Title: Progression of RSV and Influenza Pediatric ICU Admissions by Geographic Regions in the U.S.
Introduction: It has been suggested that there is an increasing trend in hospitalizations due to respiratory syncytial virus (RSV) infections among children in recent years with a decrease during the COVID-19 pandemic. This study aimed at evaluating this hypothesis along with differences in practices patterns across geographic regions in the U.S. The trends seen in pediatric intensive care units (PICUs) for RSV and influenza infections were also compared across geographic regions.
Methods: 769,913 PICU episodes from the VPS database (myvps.org) from 2014-2020 were used to study the yearly occurrence of admissions of patients < 18 years by unit-year due to RSV and Influenza in U.S. The geographic regions according to U.S. Census definition were Mid-West (MW), Northeast (NE), South (S), and West (W). Both RSV and Influenza were defined by ICD-9 and ICD-10 codes. For each of these diagnoses and geographic regions, least-squares linear fits from 2014 to 2019 were used to investigate the increase of numbers of cases per unit-year. We also investigated utilization per geographic region by estimating the percent of the top-most prevalent ventilation procedures used during the time period. Pearson correlation comparison with Fisher’s Z-transformation was used to investigate significance between the slopes of these fits.
Results: The number of cases of RSV and influenza per unit increased from 2014 to 2019. For RSV, the fastest growing rate corresponded to MW (8.4 cases per unit-year), followed by S (5.1 cases per unit-year), NE (4.7 cases per unit-year), and W (4.3 cases per unit-year). MW was different from all other regions (p < 0.001), while NE, S, and W were not different between themselves (p >0.05). All regions showed an abrupt reduction in cases per unit from 2019 to 2020. However, the trends observed for Influenza were not significantly different. Utilization of Conventional Mechanical Ventilation was not significantly different across regions but NE had higher Humidified High Flow (HFNC) utilization compared to all other regions (p < 0.001).
Conclusions: 1. In the period 2014 to 2019 there was an increase in RSV admissions to PICUs, but not influenza. 2. During the COVID-19 period a large drop in PICU admissions was found in RSV cases. 3. HFNC showed higher significant utilization in the Northeast.