(258) Oregon’s Response to a Surge in RSV-Associated Pediatric Hospitalizations in 2022

Introduction: Oregon experienced a 60% increase in RSV-associated hospitalization rates within a six-week period during the 2022-2023 respiratory season, giving rise to a statewide disaster declaration. The rapid and overwhelming demand for pediatric bedspace, consistent with the experience of children’s hospitals nationwide, prompted Oregon’s hospitals to decrease elective admissions and adopt emergency protocols to maximize pediatric capacity. There is limited data describing statewide pediatric disaster response and critical resource management during in this period. Using complementary datasets, we compared census and admission patterns in pediatric units before and through the RSV surge.

Methods: We performed a retrospective analysis of the Oregon Capacity System, which tracks the hourly census of each unit in each hospital and a statewide database of all hospital admissions. We compared the 4-week peak of the RSV surge with a 4-week baseline period, allowing for a wash-in. Admissions in the statewide database were categorized as elective vs non-elective using admission priority code, with non-elective divided into bronchiolitis and other by billing code. Statistical comparison was done using Wilcoxon rank sum and chi-squared tests.

Results: The median daily PICU census in Oregon’s hospitals increased by 50% during the surge period (24 to 36, p< 0.001), while median daily pediatric ward census increased by 18% (137 vs 162). Weekly elective pediatric admissions during the surge decreased by 20% (58.6 to 47), while bronchiolitis admissions increased by 698% (13.1 to 104.5). Non-elective other admissions increased by 33% (223.9 vs 298), of which 16% (47) were due to acute respiratory failure of alternative origin.

Conclusions: Oregon experienced a significant increase in pediatric ward and ICU census, as well as total and bronchiolitis admissions during the 2022-23 RSV surge, despite decreasing elective admissions. The increase in PICU bed demand was especially pronounced. This highlights the value of capacity monitoring systems and the need for robust pediatric disaster management planning.