Mortality prediction scores for pediatric poisonings before, during, and after the COVID-19 pandemic: analysis of the virtual pediatric systems intensive care unit database

Background Drug overdoses are one of the leading causes of pediatric hospitalizations. Mortality from pediatric drug overdoses increased during the COVID-19 pandemic. To better understand this trend, this study tracked national Pediatric Intensive Care Unit (PICU) admissions for pediatric overdoses across the periods before, during, and after the pandemic. Hypothesis We hypothesized that pediatric patients admitted to the PICU for drug overdoses involving opioids, non-opioid analgesics, anti-depressants, anti-convulsants, stimulants, alcohols, or cannabis during the PICU during the COVID-19 pandemic would have a higher probability of mortality, measured by Pediatric Index of Mortality (PIM-3) and Pediatric Risk of Mortality (PRISM-III), compared to before and after the pandemic. Methods This is a multi-center, retrospective cohort of de-identified patients aged 2–21-years admitted to the PICU between January 2019 to June 2023 using the Virtual Pediatric Systems (VPS) database. Patients were included using VPS “Star” and ICD-9 codes associated with poisoning admissions involving common drug classes. Admissions were categorized into three specified time-periods: pre-COVID, peak-COVID, and post-COVID. Primary outcomes included demographics, daily admissions for poisonings by drug class, and probability of mortality measured by PIM-3 and PRISM-III. Secondary outcomes included hospital length of stay. Results This study included 35125 poisoning admissions (13,699 males and 21,424 females) with approximately 31.0, 19.0, and 17.4 poisoning admissions per day in pre-COVID, peak-COVID, and post-COVID periods respectively ( p < 0.05). Demographics had statistically significant differences across COVID time periods for race/ethnicity, age, and sex ( p < 0.05) with white patients between 12 and 21 years comprising the most admissions over the time period. The median probability of mortality measured by PIM-3 decreased over the time period (0.73% to 0.71% to 0.66%) while PRISM remained unchanged throughout the study (0.34%). The average hospital length of stay across all drug classes increased across time periods (4.07 to 4.51 to 5.40 days; p < 0.05). Conclusion Although the probability of mortality decreased over time, the hospital length of stay increased, indicating an ongoing healthcare burden among pediatric patients admitted to the PICU with drug poisonings. These findings highlight the continued need for hospital resources for patients with acute poisoning.