Adolescent PICU Admissions in US Children’s Hospitals for Intentional Drug Intoxication During COVID

Introduction: The COVID-19 pandemic exacerbated the opioid epidemic for adults, but its impact on substance abuse among adolescents is less clear. Thus, we compared the number and outcomes of children admitted to a Pediatric Intensive Care Unit (PICU) for non-accidental drug intoxication before and during the pandemic using Pediatric Health Information System (PHIS), an administrative database for US children’s hospitals.


Methods: With IRB approval, we queried PHIS for children ages 12-18 years who were admitted to a PICU between 1/1/2017–4/30/2023 with a primary diagnosis of intentional drug use based on coding from the International Code of Disease 10th edition (ICD-10). Intoxicating agents were grouped as narcotics/opiates, cannabis, and other (cocaine, hallucinogens, etc.). Number of admissions was compared between pre-COVID (1/2017-2/2020) and COVID (3/2020-4/2023) epochs using interrupted time series (ITS) analysis. Demographics, use of invasive ventilation, and clinical outcomes were compared with chi-squared (categorical variables) or Wilcoxon rank-sum (continuous variables) tests; p< 0.05 defined statistical significance.


Results: Among 1053 admissions at 48 hospitals, 61% were male, 46% were white non-Hispanic, and 38% required invasive ventilation. There were 423 admissions pre-COVID (11.1/month) and 630 (16.6/month) during COVID, with a significant immediate increase of 3.9 admissions/month (95% CI: 0.9-6.9) after COVID onset per ITS analysis, but no significant change in slope between epochs. While sex and race did not vary between time periods, the pandemic had a higher percentage of opiate intoxications (66% vs 51%) and lower percentages of cannabis (20% vs 27%) and other drugs (14% vs 22%) (all p< 0.05). Invasive ventilation rate and PICU length of stay did not differ significantly between epochs, but mortality was increased during COVID (4.6% vs 2.1%, p=0.046).


Conclusions: In this database study of 48 children’s hospitals, we found the COVID-19 pandemic to be associated with an immediate 35% increase in the number of PICU admissions for intentional drug intoxications, an escalation of opiates as the intoxicating agents, and a mortality rate twice as high as baseline. These changes in the epidemiology and outcomes of severe adolescent drug intoxications warrant further investigation.