ABSTRACT
Importance: Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. Objectives: To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. Design, Setting, and Participants: This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. Exposure: SARS-CoV-2 detected via nucleic acid testing. Main Outcomes and Measures: Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. Results: Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). Conclusions and Relevance: In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.
Subject(s)
COVID-19 , Acute Disease , COVID-19/epidemiology , Child , Child, Preschool , Cohort Studies , Fatigue , Female , Humans , Infant , Infant, Newborn , Male , Prospective Studies , SARS-CoV-2ABSTRACT
Importance: Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. Objective: To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). Design, Setting, and Participants: This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. Exposures: Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. Main Outcomes and Measures: Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. Results: Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). Conclusions and Relevance: In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.
Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , SARS-CoV-2 , Severity of Illness Index , Adolescent , COVID-19/pathology , COVID-19 Testing , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Odds Ratio , Prospective Studies , Risk FactorsABSTRACT
Cuando llega el otoño, los profesionales en los servicios de emergencias pediátricas(SEP) se enteran antes que los árboles decidan cambiar las hojas. El aumento en el número de pacientes es tan importante como la repetición de los motivos de consulta y de las explicaciones sobre la futilidad de los ¨tratamientos para los virus¨. Además de los resfríos con y sin fiebre que llevan al SEP al colapso, están los cuadros severos de bronquiolitis, laringitis, crisis asmáticas y neumonías que demandan una atención especializada. When fall arrives, pediatric emergency services (SEP) professionals know before the trees decide to change their leaves. The increase in the number of patients is as important as the repetition of the reasons for consultation and the explanations about the futility of ¨treatments for viruses¨. In addition to colds with and without fever that lead EPS to collapse, there are severe symptoms of bronchiolitis, laryngitis, asthma attacks and pneumonia that demand specialized care.
ABSTRACT
Cuando llega el otoño, los profesionales en los servicios de emergencias pediátricas(SEP) se enteran antes que los árboles decidan cambiar las hojas. El aumento en el número de pacientes es tan importante como la repetición de los motivos de consulta y de las explicaciones sobre la futilidad de los ¨tratamientos para los virus¨. Además de los resfríos con y sin fiebre que llevan al SEP al colapso, están los cuadros severos de bronquiolitis, laringitis, crisis asmáticas y neumonías que demandan una atención especializada. When fall arrives, pediatric emergency services (SEP) professionals know before the trees decide to change their leaves. The increase in the number of patients is as important as the repetition of the reasons for consultation and the explanations about the futility of ¨treatments for viruses¨. In addition to colds with and without fever that lead EPS to collapse, there are severe symptoms of bronchiolitis, laryngitis, asthma attacks and pneumonia that demand specialized care.
ABSTRACT
ABSTRACT Introduction: The epidemiological and clinical patterns of COVID-19 infection remain unclear, especially among children. Objective: To describe epidemiological and clinical aspects of COVID-19 cases treated in a Pediatric Emergency Department between March and September 2020. Materials and Methods: This was an observational, descriptive and retrospective study of a series of consecutive cases. Patients aged 0-18 years were included in a non-probability sampling. The variables analyzed were: demographic data, pediatric evaluation triangle, contact situation, symptoms, clinical picture, hospitalization, nutritional status, laboratory analysis and images. Data were analyzed in SPSS V21 using descriptive statistics Results: 56 patients were admitted. 37.5% were under 2 years old and 32% had comorbid conditions. 51.8% were hospitalized. The median time of hospitalization was 48 (P25 6- P75 90) hours. The predominant clinical picture was lower airway infection. 9% presented severe or critical symptoms, and 5.4% were admitted to intensive care. There was 1 deceased patient, who had severe comorbidities. The PCR was performed with a median of 4 days (min. 0 max. 10) of symptom onset Conclusion: More than a third of the patients with Covid -19 were under 2 years of age and 32% had a comorbidity. The clinical picture was mild in 70% of the cases, although more than half were hospitalized and 5.4% were admitted to intensive care. The most frequent clinical presentation was upper airway involvement followed by pneumonia. One patient with severe comorbidities died.
ABSTRACT
ABSTRACT Introduction: The epidemiological and clinical patterns of COVID-19 infection remain unclear, especially among children. Objective: To describe epidemiological and clinical aspects of COVID-19 cases treated in a Pediatric Emergency Department between March and September 2020. Materials and Methods: This was an observational, descriptive and retrospective study of a series of consecutive cases. Patients aged 0-18 years were included in a non-probability sampling. The variables analyzed were: demographic data, pediatric evaluation triangle, contact situation, symptoms, clinical picture, hospitalization, nutritional status, laboratory analysis and images. Data were analyzed in SPSS V21 using descriptive statistics Results: 56 patients were admitted. 37.5% were under 2 years old and 32% had comorbid conditions. 51.8% were hospitalized. The median time of hospitalization was 48 (P25 6- P75 90) hours. The predominant clinical picture was lower airway infection. 9% presented severe or critical symptoms, and 5.4% were admitted to intensive care. There was 1 deceased patient, who had severe comorbidities. The PCR was performed with a median of 4 days (min. 0 max. 10) of symptom onset Conclusion: More than a third of the patients with Covid -19 were under 2 years of age and 32% had a comorbidity. The clinical picture was mild in 70% of the cases, although more than half were hospitalized and 5.4% were admitted to intensive care. The most frequent clinical presentation was upper airway involvement followed by pneumonia. One patient with severe comorbidities died.