Volume and Severity of Pediatric COVID-19 Hospitalizations in the United States

Abstract

OBJECTIVES Using administrative data from pediatric hospitals in the United States, we examined trends in coronavirus disease 2019 (COVID-19) hospitalizations and severity of disease among children. METHODS We extracted data from the Pediatric Health Information System for hospitalized patients less than 12 years old with COVID-19 (identified by primary or secondary International Classification of Diseases-10 diagnosis code U07.1) admitted from April 2020 to August 2022. We examined weekly trends in COVID hospitalization volume overall and by ICU utilization as a measure of severe disease and by COVID diagnosis hierarchy (primary versus secondary) as a proxy for incidental admissions. We estimated the annualized trend in the ratio of hospitalizations requiring, versus not requiring, ICU care and the trend in ratio of hospitalizations with a primary versus secondary COVID diagnosis. RESULTS We included 38 160 hospitalizations across 45 hospitals. Median age was 2.4 years (interquartile range = 0.7–6.6). Median length of stay was 2.0 days (interquartile range = 1–4). ICU-level care was required for 18.9% and 53.8% had a primary diagnosis of COVID-19. The ratio of ICU to non-ICU admissions declined by 14.5% annually (95% confidence interval: −21.7% to −7.26%; P < .001), whereas the ratio of primary to secondary diagnosis was stable (11.7% annually; 95% confidence interval: −8.83% to 32.4%; P = .26). CONCLUSIONS Periodic increases in pediatric COVID-19 hospitalizations with are evident. However, there is no evidence of corresponding increase in severity of illness that may provide context for recent reports of increasing pediatric COVID hospitalizations in addition to health policy implications.