Inter-hospital Variation in COVID-19 Era Pediatric Hospitalizations by Age Group and Diagnosis

BACKGROUND Mitigation strategies and public responses to coronavirus disease 2019 (COVID-19) varied geographically and may have differentially affected burden of pediatric disease and hospitalization practices. We aimed to quantify hospital-specific variation in hospitalizations during the COVID-19 era. METHODS Using Pediatric Health Information Systems data from 44 Children’s Hospitals, this retrospective multicenter analysis compared hospitalizations of children (1 day–17 years) from the COVID-19 era (March 1, 2020–June 30, 2021) to prepandemic (January 1, 2017–December 31, 2019). Variation in the magnitude of hospital-specific decline between eras was determined using coefficients of variation (CV). Spearman’s test was used to assess correlation of variation with community and hospital factors. RESULTS The COVID-19 era decline in hospitalizations varied between hospitals (CV 0.41) and was moderately correlated with declines in respiratory infection hospitalizations (r = 0.69, P < .001). There was no correlation with community or hospital factors. COVID-19 era changes in hospitalizations for mental health conditions varied widely between centers (CV 2.58). Overall, 22.7% of hospitals saw increased admissions for adolescents, and 29.5% saw increases for newborns 1 to 14 days, representing significant center-specific variation (CV 2.30 for adolescents and 1.98 for newborns). CONCLUSIONS Pandemic-era change in hospitalizations varied across institutions, partially because of hospital-specific changes in respiratory infections. Residual variation exists for mental health conditions and in groups least likely to be admitted for respiratory infections, suggesting that noninfectious conditions may be differentially and uniquely affected by local policies and hospital-specific practices enacted during the COVID-19 era.