Impacts of COVID-19 related shelter-in-place mandates on hospital-based care for pediatric neurological diagnoses

Objective: To determine the immediate impacts of the COVID-19 Shelter-in-Place mandates (SIPM) on utilization of emergency room and inpatient care for patients with neurological diagnoses at pediatric hospitals. Background: The Coronavirus 2019 (COVID-19) pandemic lead to SIPM across the US to decrease transmission and alleviate pressure on healthcare systems, including recommendations to avoid elective hospitalizations. We hypothesized SIPM resulted in decreased hospital encounters for pediatric neurological diagnoses. Design/Methods: This retrospective cross-sectional study included all emergency, urgent-care and inpatient encounters with a neurological primary admission or discharge ICD-10 diagnosis code during the six-weeks post SIPM or same six-week timeframe from the prior three years from five US pediatric institutions. Patient demographics, length of encounter, utilization of neuroimaging, and EEG were extracted from the medical record. Results: Over four years and With in the six-week timeframes there were 20,504 included encounters. During SIPM there was a 51% (p<0.001) reduction in neurological hospital-based encounters. Patients were younger (median 7yrs vs. 5.1yrs, p<0.001), and encounters for African Americans decreased (OR 0.88 CI 0.79-0.98, p=0.02) compared to prior years. During SIPM length of stay increased by one day (median 2 vs. 3 days, p<0.01), and relative utilization of intensive care increased by 66% (p<0.01). Migraine encounters had a relative decrease during SIPM by 47% (12.8%-8.0%, p<0.001). Emergent diagnoses had relative increases, with admissions for TBI increasing 60% (13.5%-21.6%, p<0.001) and status epilepticus 38% (9.1%- 12.62%, p=0.003). Diagnostic testing proportionally increased including: continuous EEG (20%, p<0.01), brain MRI (55%, p<0.001), and head CT (60%, p<0.001). Conclusions: COVID-19 SIPM led to overall decreased utilization of hospital-based care for neurological diagnosis and a relative increase in neurological emergencies, utilization of intensive care, EEG, and neuroimaging. These data support preserved staffing of hospital-based neurological services during SIPM. Further studies are needed to determine the impact of increased imaging, racial disparities, and potentially delayed diagnosis or treatment.