Pediatric Bed Capacity, Bed Strain, and Load Imbalance During the 2022 Respiratory Viral Season.

Importance: During the 2022 respiratory viral surge, anecdotal evidence suggested that pediatric bed strain and load imbalance (hospitals in the same region experiencing disparate occupancy rates) may be linked to pediatric bed capacity changes during the preceding decade. Objectives: To determine the prevalence of pediatric bed strain and load imbalance by hospital referral region (HRR) and to evaluate the association between 2010-2021 pediatric bed capacity changes and bed strain and load imbalance during the 2022 respiratory viral season. Design, Setting, and Participants: This cross-sectional analysis of weekly mean bed strain and load imbalance from September 30, 2022, through January 5, 2023, used US Department of Health and Human Services data; longitudinal analysis of 2010-2021 pediatric bed capacity used American Hospital Association survey data. A total of 254 HRRs throughout the US were included. For bed strain analyses, inclusion criteria consisted of having at least 1 pediatric acute care bed; for load imbalance analyses, at least 2 hospitals, each with at least 1 pediatric acute care bed. Hospitals with missing data for at least 2 consecutive weeks in the study period were excluded. Data were analyzed from February 7, 2023, to July 2, 2025. Main Outcomes and Measures: Bed strain, defined as more than 85% of pediatric acute care beds in the HRR occupied, and load imbalance, defined as at least 1 hospital with at least 85% pediatric beds occupied, at least 1 hospital with less than 85% pediatric beds occupied, and a difference of at least 20% in pediatric bed occupancy between hospitals with the highest and lowest occupancies in the HRR. Results: Of 254 HRRs included in the analysis, a mean of 112 (44.1%) experienced pediatric bed strain per week. Of 123 HRRs with at least 2 hospitals with pediatric beds, a mean of 82 (66.7%) experienced pediatric load imbalance per week. In the 254 HRRs included in the analysis of pediatric bed strain, the number of pediatric beds per 10 000 children decreased from 4.57 in 2010 to 4.02 beds (12.0% decrease) in 2021. There was no association between 2010-2021 HRR-level pediatric bed capacity changes and 2022 pediatric bed strain or load imbalance. Conclusions and Relevance: In this cross-sectional analysis of the 2022 respiratory viral season, bed strain and load imbalance were common but not associated with declines in pediatric bed capacity since 2010. Regionalization efforts may prevent capacity overload and load imbalance during future surges.