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Factors Associated With COVID-19 Disease Severity in US Children and Adolescents
James W Antoon1, Carlos G Grijalva2, Cary Thurm3
1Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
COVID-19 hospitalization in children and adolescents was linked to factors like obesity and certain diseases. Older children faced higher severity risks, highlighting disparities in care.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Limited understanding of clinical factors influencing COVID-19 severity in pediatric populations.
- Need for data on risk factors for severe COVID-19 outcomes in children and adolescents.
Purpose of the Study:
- To identify clinical factors associated with COVID-19 hospitalization in children and adolescents.
- To determine factors linked to clinical severity among hospitalized pediatric COVID-19 patients.
Main Methods:
- Retrospective cohort study of pediatric patients diagnosed with COVID-19 across 45 US children's hospitals (April-September 2020).
- Assessment of factors associated with emergency department discharge versus hospitalization.
- Evaluation of factors correlated with clinical severity (ICU admission, mechanical ventilation, shock, death) in hospitalized patients.
Main Results:
- Of 19,976 COVID-19 encounters, 20.3% resulted in hospitalization.
- Hospitalization was associated with private insurance, obesity/type 2 diabetes mellitus, asthma, cardiovascular disease, immunocompromised status, pulmonary disease, and neurologic disease.
- Greater disease severity in hospitalized children was linked to Black or other non-White race, age over 4 years, and comorbidities including obesity/type 2 DM, cardiovascular, neuromuscular, and pulmonary conditions.
Conclusions:
- Twenty percent of pediatric COVID-19 patients presenting to US children's hospitals were hospitalized, with 21% of those requiring intensive care.
- Older children had lower hospitalization risk but increased severity when hospitalized.
- Disparities in disease severity by race, ethnicity, and comorbidities underscore the need for targeted mitigation and vaccination strategies.
Background:
Little is known about the clinical factors associated with COVID-19 disease severity in children and adolescents.
Methods:
We conducted a retrospective cohort study across 45 US children's hospitals between April 2020 to September 2020 of pediatric patients discharged with a primary diagnosis of COVID-19. We assessed factors associated with hospitalization and factors associated with clinical severity (eg, admission to inpatient floor, admission to intensive care unit [ICU], admission to ICU with mechanical ventilation, shock, death) among those hospitalized.
Results:
Among 19,976 COVID-19 encounters, 15,913 (79.7%) patients were discharged from the emergency department (ED) and 4063 (20.3%) were hospitalized. The clinical severity distribution among those hospitalized was moderate (3222, 79.3%), severe (431, 11.3%), and very severe (380, 9.4%). Factors associated with hospitalization vs discharge from the ED included private payor insurance (adjusted odds ratio [aOR],1.16; 95% CI, 1.1-1.3), obesity/type 2 diabetes mellitus (type 2 DM) (aOR, 10.4; 95% CI, 8.9-13.3), asthma (aOR, 1.4; 95% CI, 1.3-1.6), cardiovascular disease, (aOR, 5.0; 95% CI, 4.3- 5.8), immunocompromised condition (aOR, 5.9; 95% CI, 5.0-6.7), pulmonary disease (aOR, 5.3; 95% CI, 3.4-8.2), and neurologic disease (aOR, 3.2; 95% CI, 2.7-5.8). Among children and adolescents hospitalized with COVID-19, greater disease severity was associated with Black or other non-White race; age greater than 4 years; and obesity/type 2 DM, cardiovascular, neuromuscular, and pulmonary conditions.
Conclusions:
Among children and adolescents presenting to US children's hospital EDs with COVID-19, 20% were hospitalized; of these, 21% received care in the ICU. Older children and adolescents had a lower risk for hospitalization but more severe illness when hospitalized. There were differences in disease severity by race and ethnicity and the presence of selected comorbidities. These factors should be taken into consideration when prioritizing mitigation and vaccination strategies.
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