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The first 1000 symptomatic pediatric SARS-CoV-2 infections in an integrated health care system: a prospective cohort
Leigh M Howard1, Kathryn Garguilo1, Jessica Gillon1
1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Most pediatric COVID-19 cases are mild, with few hospitalizations. Key predictors for severe illness in children include pre-existing conditions, Black race, Hispanic ethnicity, dyspnea, and vomiting.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- The clinical spectrum and severity predictors for pediatric SARS-CoV-2 infections remain incompletely understood.
- Understanding these factors is crucial for effective management and resource allocation in pediatric healthcare settings.
Purpose of the Study:
- To investigate the spectrum of illness and identify predictors of hospitalization in children diagnosed with SARS-CoV-2.
- To characterize the clinical presentation and outcomes of pediatric COVID-19 cases.
Main Methods:
- Active surveillance of symptomatic pediatric patients using polymerase chain reaction (PCR) for SARS-CoV-2.
- Collection of sociodemographic and clinical data through phone follow-up and medical record review at 5 and 30 days post-diagnosis.
- Logistic regression analysis to determine predictors of hospitalization.
Main Results:
- Among the first 1000 pediatric patients, 4% were hospitalized, with 0.8% requiring ICU admission and <0.1% needing mechanical ventilation.
- Common symptoms included cough (52%), headache (43%), and sore throat (36%).
- Strongest predictors of hospitalization were pre-existing medical conditions (OR 7.7), dyspnea (OR 6.8), Black race or Hispanic ethnicity (OR 2.7), and vomiting (OR 5.4).
Conclusions:
- The majority of SARS-CoV-2 infections in pediatric patients present with mild illness, rarely necessitating hospitalization.
- Identified pediatric hospitalization predictors, including comorbidities and specific demographic factors, differ from those observed in adult populations.
Background:
The spectrum of illness and predictors of severity among children with SARS-CoV-2 infection are incompletely understood.
Methods:
Active 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.
Results:
The 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).
Conclusions:
In 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.
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