Which children and young people are at higher risk of severe disease and death after hospitalisation with SARS-CoV-2 infection in children and young people: A systematic review and individual patient meta-analysis

  1. Rachel Harwood
  2. Helen Yan
  3. Nishanthi Talawila Da Camara
  4. Clare Smith
  5. Joseph Ward
  6. Catrin Tudur-Smith
  7. Michael Linney
  8. Matthew Clark
  9. Elizabeth Whittaker
  10. Defne Saatci
  11. Peter J. Davis
  12. Karen Luyt
  13. Elizabeth S. Draper
  14. Simon E Kenny
  15. Lorna K. Fraser
  16. Russell M. Viner

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Abstract

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  1. Version published to 10.1016/j.eclinm.2022.101287
  2. ScreenIT

    SciScore for 10.1101/2021.06.30.21259763: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableAnalysis: Meta-analyses were undertaken separately for COVID-19 and PIMS-TS/MIS-C to examine the association of each clinical outcome with sex (female sex was the reference group), age-group (1-4 years as reference group) and comorbidities (children without any comorbidity were the reference group).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search: We performed a systematic search of four major databases: PubMed, European PMC, Scopus and Embase for relevant studies on COVID-19 in children and young people up to 21 years of age, published between the 1st January 2020 and the 29th January 2021 and updated the search on the 21st May 2021.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    First, we undertook a random-effects meta-analysis of reported study-level data using RevMan 5 software (18) to estimate pooled odds-ratios for each outcome (death, intensive care admission, mechanical invasive ventilation and cardiovascular support).
    RevMan
    suggested: (RevMan, RRID:SCR_003581)
    The second set of meta-analyses were undertaken on the IPD, using multi-level logistic mixed-effects models in Stata 16 (StataCorp.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: We undertook a high quality systematic review and meta-analysis, including use of individual patient data to provide more detailed analysis of comorbidities, including obesity and trisomy 21. Findings were largely consistent across the aggregate and the IPD analyses, with some exceptions. Findings from a sensitivity analysis excluding the largest study and from a two-stage meta-analysis of the IPD were highly similar to those described above. Our data are subject to a number of limitations. Twenty-two of 57 studies (39%) provided individual patient data; systematic differences between these groups may have introduced bias. There were very small numbers with PIMS-TS/MIS-C in some analyses, particularly the IPD analyses. We were unable to examine ethnicity and socioeconomic position as risk factors due to lack of data in included studies. Included studies were highly heterogenous and from a wide range of resource settings, and it is likely that findings were influenced by differing national approaches to hospitalisation of infected children and by differences in availability and use of resources including intensive care beds. A number of East Asian countries hospitalised all children who were SARS-CoV-2 positive, regardless of symptoms, whilst other countries limited hospitalisation to symptomatic children or those with significant illness. Policies on admission to and access to critical care likely also differed between countries(31). The novel natur...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.06.30.21259763v1 on medRxiv