Abstract
BackgroundThe spectrum of illness and predictors of severity among children with SARS-CoV-2 infection are incompletely understood.MethodsActive surveillance was performed for SARS-CoV-2 by polymerase chain reaction among symptomatic pediatric patients in a quaternary care academic hospital laboratory beginning March 12, 2020. We obtained sociodemographic and clinical data 5 (+/-3) and 30 days after diagnosis via phone follow-up and medical record review. Logistic regression was used to assess predictors of hospitalization.ResultsThe first 1000 symptomatic pediatric patients were diagnosed in our institution between March 13, 2020 and September 28, 2020. Cough (52 %), headache (43 %), and sore throat (36 %) were the most common symptoms. Forty-one (4 %) were hospitalized; 8 required ICU admission, and 2 required mechanical ventilation (< 1 %). One patient developed multisystem inflammatory syndrome in children; one death was possibly associated with SARS-CoV-2 infection. Symptom resolution occurred by follow-up day 5 in 398/892 (45 %) patients and by day 30 in 443/471 (94 %) patients. Pre-existing medical condition (OR 7.7; 95 % CI 3.9–16.0), dyspnea (OR 6.8; 95 % CI 3.2–14.1), Black race or Hispanic ethnicity (OR 2.7; 95 % CI 1.3–5.5), and vomiting (OR 5.4; 95 % CI 1.2–20.6) were the strongest predictors of hospitalization. The model displayed excellent discriminative ability (AUC = 0.82, 95 % CI 0.76–0.88, Brier score = 0.03).ConclusionsIn 1000 pediatric patients with systematic follow-up, most SARS-CoV-2 infections were mild, brief, and rarely required hospitalization. Pediatric predictors of hospitalization included comorbid conditions, Black race, Hispanic ethnicity, dyspnea and vomiting and were distinct from those reported among adults.
Highlights
The spectrum of illness and predictors of severity among children with SARS-CoV-2 infection are incompletely understood
Our objectives were to report the sociodemographic and clinical characteristics, including duration of symptoms, and clinical outcomes of children and adolescents diagnosed with SARS-CoV-2 infection in a large, integrated health network affiliated with an urban academic medical center in the southern United States (U.S.) and to identify predictors of hospitalization in these children
SARS-CoV-2 testing was offered in the inpatient, emergency department (ED), and ambulatory settings, which includes a primary care network, 9 urgent care clinics that see pediatric patients, 6 pediatric-only urgent care clinics, 2 dedicated oncampus SARS-CoV-2 testing sites, and 14 urgent care clinics located within private retail pharmacies
Summary
The spectrum of illness and predictors of severity among children with SARS-CoV-2 infection are incompletely understood. The spectrum of illness associated with SARS-CoV-2 infection in children is broad, including asymptomatic viral detection, and Howard et al BMC Pediatrics (2021) 21:403 known as multisystem inflammatory syndrome in children (MIS-C) [9,10,11,12,13,14]. Less is known regarding the symptoms, illness duration, and predictors of severe illness among ambulatory children diagnosed in the community with SARSCoV-2 infection. Our objectives were to report the sociodemographic and clinical characteristics, including duration of symptoms, and clinical outcomes of children and adolescents diagnosed with SARS-CoV-2 infection in a large, integrated health network affiliated with an urban academic medical center in the southern United States (U.S.) and to identify predictors of hospitalization in these children. Specimens were nasopharyngeal or nasal swabs in viral transport media
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