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Published on: September 24, 2020
COVID-19 in 17 Italian Pediatric Emergency Departments
Niccolò Parri1, Matteo Lenge2,3,4, Barbara Cantoni5
1Department of Emergency Medicine and Trauma Center, niccolo.parri@meyer.it.
Insights
Pediatric COVID-19 cases often present with mild symptoms, posing challenges for emergency departments. Early recognition is key for disease control, as children can transmit the virus.
Area of Science:
- Pediatric Infectious Diseases
- Emergency Medicine
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) presents variably in children, complicating early recognition in emergency departments (EDs).
- Effective disease control and prevention strategies depend on accurate identification of pediatric COVID-19 cases.
Purpose of the Study:
- To describe a cohort of 170 children diagnosed with COVID-19 in Italian pediatric EDs.
- To compare findings with previously published pediatric COVID-19 cohorts.
Main Methods:
- Retrospective chart review of children aged 0-18 years.
- Data collected from 17 pediatric emergency departments across Italy.
Main Results:
- A high proportion of patients were under one year old (median age 45 months).
- Most children presented with asymptomatic (17%) or mild (63%) disease, with cough and feeding difficulties being common symptoms.
- Radiological imaging was minimally utilized, potentially leading to under-identification of moderate cases.
Conclusions:
- Pediatric COVID-19 cases in Italian EDs often lack severe symptoms, representing an organizational challenge rather than a frequent severe illness.
- Children can be significant sources of viral transmission, necessitating continued vigilance and preparedness.
- A clinical classification approach may be more effective than radiological methods for resource allocation and predicting patient needs.
Background:
Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts.
Methods:
Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs.
Results:
In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases.
Conclusions:
Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
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