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American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID-19
Dawn M Wahezi1, Mindy S Lo2, Tamar B Rubinstein1
1Children's Hospital at Montefiore and Albert Einstein College of Medicine, New York, New York, United States.
Insights
Children with pediatric rheumatic diseases (PRD) are not at increased risk for COVID-19 infection. This guidance provides clinical recommendations for managing PRD during the pandemic, acknowledging evolving research.
Area of Science:
- Pediatric Rheumatology
- Infectious Diseases
- Public Health
Background:
- The coronavirus disease 2019 (COVID-19) pandemic created challenges for managing pediatric rheumatic diseases (PRD).
- There was a need for clinical guidance for healthcare providers treating children with PRD during this unprecedented time.
Purpose of the Study:
- To develop evidence-based clinical guidance for rheumatology providers managing children with PRD during the COVID-19 pandemic.
- To address clinical questions and provide consensus-based recommendations.
Main Methods:
- A task force of pediatric rheumatologists and infectious disease specialists was convened.
- Guidance statements were developed using a modified Delphi approach with asynchronous voting.
- Consensus was defined by median scores and levels of agreement (moderate or high).
Main Results:
- 33 final guidance statements were approved by the task force.
- All statements achieved high agreement, with 28 reaching high consensus and 5 moderate consensus.
- The guidance indicates children with PRD are not at increased risk for SARS-CoV-2 infection.
Conclusions:
- The developed guidance statements offer clinical recommendations for managing pediatric rheumatic diseases during the COVID-19 pandemic.
- This guidance is a living document, subject to updates as scientific understanding of COVID-19 evolves.
Objective:
To provide clinical guidance to rheumatology providers who treat children with pediatric rheumatic disease (PRD) in the context of the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, 1 adult rheumatologist, and 1 pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on a review of the queries posed by the patients as well as the families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with 3 rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9-point numeric scoring system with predefined levels of agreement (categorized as disagreement, uncertainty, or agreement, with median scores of 1-3, 4-6, and 7-9, respectively) and consensus (categorized as low, moderate, or high). To be approved as a guidance statement, median vote ratings were required to fall into the highest tertile for agreement, with either moderate or high levels of consensus.
Results:
To date, 39 guidance statements have been approved by the task force. Those with similar recommendations were combined to form a total of 33 final guidance statements, all of which received median vote ratings within the highest tertile of agreement and were associated with either moderate consensus (n = 5) or high consensus (n = 28).
Conclusion:
These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS-CoV-2 infection. This guidance is presented as a "living document," recognizing that the literature on COVID-19 is rapidly evolving, with future updates anticipated.
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