Trends in Disease Severity Among Critically Ill Children With Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Multicenter Cohort Study in the United States.
Trends in Disease Severity Among Critically Ill Children With Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Multicenter Cohort Study in the United States.
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患有严重急性呼吸系统综合症冠状病毒 2 的危重儿童的疾病严重程度趋势：美国的一项回顾性多中心队列研究。
DOI：
10.1097/pcc.0000000000003105
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发表时间：
2023
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作者：
Ross,CatherineE;Burns,JeffreyP;Grossestreuer,AnneV;Bhattarai,Pallav;McKiernan,ChristineA;Franks,JenniferD;Lehmann,Sonja;Sorcher,JillL;Sharron,MatthewP;Wai,Kitman;Al-Wahab,Haitham;Boukas,Konstantinos;Hall,MarkW;Ru,George;
目的：描述 COVID-19 大流行期间儿童严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染引起的危重疾病的趋势。我们假设 Omicron 时期的 PICU 入院率高于原始疫情期间，但需要气管插管的患者较少。设计：回顾性队列研究。背景：这项研究在 2022 年 1 月（Omicron 时期）在 9 个美国 PICU 中进行，历时 3 周，而 2020 年 3 月（原始时期）则为 3 周。患者：筛查呈阳性的 21 岁以下患者包括通过聚合酶链反应或医院快速抗原检测来检测 SARS-CoV-2 感染并入住 PICU 或中级监护病房的患者。干预措施：无。测量和主要结果：总共对 267 名患者（239 名 Omicron 患者和 28 名原始患者）进行了审查。 Omicron 队列中有 45 名患者偶然感染 SARS-CoV-2，因此被排除在分析之外。与原始队列患者相比，Omicron 队列患者更年轻（中位[四分位距]，6 岁[1.3-13.3 岁] vs 14 岁[8.3-17.3 岁]；p= 0.001）。与原始时期相比，Omicron 时期与每个机构 13 名患者入院 COVID-19 相关的 PICU 患者平均增加有关（95% CI，6-36；p = 0.008），这意味着入院绝对人数增加了 7 倍。我们未能确定队列周期（Omicron 与原始）和插管几率之间的关联（优势比，0.7；95% CI，0.3-1.7）。然而，我们不能排除插管次数减少高达 70% 的可能性。结论：Omicron 浪潮中与 COVID-19 相关的 PICU 入院人数比最初爆发时增加了 7 倍。我们不能排除 Omicron 时期插管使用量比原始时期减少高达 70% 的可能性，这可能代表后期 PICU/医院入院政策的差异，或疾病模式的差异，也可能是疫苗接种的影响。
OBJECTIVES:To describe trends in critical illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children over the course of the COVID-19 pandemic. We hypothesized that PICU admission rates were higher in the Omicron period compared with the original outbreak but that fewer patients needed endotracheal intubation.DESIGN:Retrospective cohort study.SETTING:This study took place in nine US PICUs over 3 weeks in January 2022 (Omicron period) compared with 3 weeks in March 2020 (original period).PATIENTS:Patients less than or equal to 21 years old who screened positive for SARS-CoV-2 infection by polymerase chain reaction or hospital-based rapid antigen test and were admitted to a PICU or intermediate care unit were included.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:A total of 267 patients (239 Omicron and 28 original) were reviewed. Forty-five patients in the Omicron cohort had incidental SARS-CoV-2 and were excluded from analysis. The Omicron cohort patients were younger compared with the original cohort patients (median [interquartile range], 6 yr [1.3–13.3 yr] vs 14 yr [8.3–17.3 yr]; p= 0.001). The Omicron period, compared with the original period, was associated with an average increase in COVID-19–related PICU admissions of 13 patients per institution (95% CI, 6–36; p= 0.008), which represents a seven-fold increase in the absolute number admissions. We failed to identify an association between cohort period (Omicron vs original) and odds of intubation (odds ratio, 0.7; 95% CI, 0.3–1.7). However, we cannot exclude the possibility of up to 70% reduction in intubation.CONCLUSIONS:COVID-19–related PICU admissions were seven times higher in the Omicron wave compared with the original outbreak. We could not exclude the possibility of up to 70% reduction in use of intubation in the Omicron versus original epoch, which may represent differences in PICU/hospital admission policy in the later period, or pattern of disease, or possibly the impact of vaccination.