230: ASSOCIATION BETWEEN THE COVID-19 PANDEMIC AND ICU UTILIZATION FOR CHILDREN WITH HYPERGLYCEMIC CRISIS

Abstract

Introduction: Admissions to the intensive care unit (ICU) for children with hyperglycemic crisis (HGC, defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or hyperosmolar ketoacidosis) increased during the COVID-19 pandemic, possibly from social distancing resulting in decreased or delayed health care access. We sought to determine if severity of illness for HGC changed from pandemic year 1 to year 2 as social distancing restrictions lightened. Methods: Retrospective study of children ≤ 18 y/o hospitalized from 3/2017 to 3/2022 in the Pediatric Health Information System for HGC. PreCOVID years (3/2017-3/2020), COVID-19 year 1 (3/2020-3/2021), and COVID-19 year 2 (3/2021-3/2022). The primary outcome was ICU admission. Secondary outcomes included ICU length of stay (LOS) >3 days, use of therapies for neurologic compromise, and cost. Results: From 42 hospitals, 46,220 patients were admitted with HGC, of these, 19,889 patients were admitted to the ICU. There was a decrease in ICU admissions from COVID-19 year 1 (47.4%) to year 2 (44.6%) but both remained higher than PreCOVID (40.7%). Median admission cost remained elevated in year 1 ($11,134 [IQR $6,412, $13,060) and year 2 ($11,057 [IQR $7,974, $15,997]) compared to PreCovid ($9,206 [IQR $7,741, $16,069]). In multivariable analysis, when compared to PreCOVID, ICU admissions for HGC were higher in COVID-19 year 1 (OR 1.31 [95%CI 1.25–1.37], p< 0.01) and year 2 (OR 1.16 [95% CI 1.10–1.22], p< 0.01) after controlling for confounding variables. However, ICU admissions were higher in year 1 than year 2 (OR 1.13, 95% CI [1.075-1.20], p=< 0.01). ICU LOS >3days increased when compared to PreCOVID years (COVID-19 Year 1: OR 1.70, [95% CI: 1.38-2.09], p< 0.01, Year 2: OR: 1.6 [95% CI 1.3-1.97], p< 0.001) but there was no difference between year 1 and 2 (p=0.6). Therapies for neurologic compromise increased in COVID-19 year 1 (p< 0.01) and year 2 (p < 0.01) in comparison to PreCOVID years but there was no change between COVID-19 years (p=0.15). Conclusions: During the COVID-19 pandemic, children with HGC were admitted with a higher severity of illness than pre-COVID. This pattern continued during Covid-19 year 2 despite reduction in social distancing although need for ICU admission was higher in COVID-19 Year 1 than Year 2.