O2063: Burden of Viral Bronchiolitis on Children’s and Non-children’s Hospitals in the US During the 2022 Surge

Background: Due to the COVID-19 pandemic, there have been significant fluctuations and timing shift in viral bronchiolitis, often secondary to respiratory syncytial virus infection. The surge in hospitalizations among children ≤ 4 years of age during late 2022 surpassed pediatric bed capacity in many states. The precise impact of this surge on children’s hospitals versus non-children's hospitals is unknown.

Methods: We analyzed RSV and other viral bronchiolitis (ICD-10 codes J210, J218, J219) admission and transfer trends among children (0-17 y) from January 2019 to December 2022 by hospital cohort (non-children’s hospitals, n=269 and children’s hospitals, n=89) in the Vizient® Clinical Data Base. Only hospitals with consistent data submitted every month during this period were included in the analysis. Birth discharges were excluded. Mann-Kendall trend tests were used to assess periodic changes.

Results: Overall pediatric viral bronchiolitis inpatient admissions increased 20% in 2022 compared to 2019 (25,177 from 20,923) (P <.001) and decreased 57% from 2019 to 2020 (8,988) (P <.001). The increase in 2022 was accompanied by a 58% increase in intensive care unit utilization at non-children’s hospitals from 2019-2022 (183 to 290) (P <.001) and a 30% increase at children’s hospitals (4,655 to 6,041) (P=.018). The seasonal surge in 2021 started early in Q2, however total annual admissions (18,482) did not surpass 2019 volumes (Figure 1a), though ICU utilization rate peaked at both sites of service (Figure 1b). In 2022, the viral bronchiolitis discharge rate significantly increased beyond seasonal fluctuations in Q4 at both children’s hospitals and non-children’s hospitals, with the biggest increase seen among children aged 1-4 years at non-children’s hospitals (87% increase in Q42022 from Q42019 (P <.001)) (Figure 1c). The number of overall inbound transfer volumes notably declined in 2020, returned to pre-pandemic levels in 2021 and peaked in Q4 2022 (Figure 2a). Overall transfer rates (transfer/admissions) remained stable at children’s hospitals (24%) but increased 33% at non-children’s hospitals (10% in Q42019 vs 13.3% in Q42022) (Figure 2b), similar to viral bronchiolitis trends (Figure 2c). Viral bronchiolitis transfers account for a significantly higher portion of overall transfers in Q42022 at both sites: 11% at children’s hospitals (P <.001) and 14% at non-children’s hospitals (P <.001) (Figure 2d). Median transfer distance among viral bronchiolitis transfers to children’s hospitals increased 11% from 2019-2020 (29.3 [12.4-57.7] to 32.5 [13.9-63.7] miles) and remained elevated through 2022 (32.6 [14.9-61.1] miles).

Conclusion: The viral bronchiolitis inpatient and ICU burden in late 2022 was markedly higher at non-children’s and children’s hospitals compared to pre-pandemic levels, though the impact was most significant for non-children’s hospitals. Transfer distances for pediatric viral bronchiolitis patients has increased since the pandemic onset. A strategic evaluation of optimal pediatric bed and ICU capacity in both non-children’s and children’s hospitals is needed to handle future seasonal surges in pediatric admissions.