Review of clinical characteristics and laboratory findings of COVID-19 in children-Systematic review and Meta-analysis

  1. Harmeet Kaur Kharoud
  2. Rizwana Asim
  3. Lianne Siegel
  4. Lovepreet Chahal
  5. Gagan Deep Singh

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Abstract

OBJECTIVE

To conduct a systematic review and meta-analysis to assess the prevalence of various clinical symptoms and laboratory findings of COVID-19 in children.

METHODS

PubMed, MEDLINE, and SCOPUS databases were searched to include studies conducted between January 1, 2020, and July 15, 2020 which reported data about clinical characteristics and laboratory findings in laboratory-confirmed diagnosis of COVID-19 in pediatric patients. Random effects meta-analysis using generalized linear mixed models was used to estimate the pooled prevalence.

RESULTS

The most prevalent symptom of COVID-19 in children was 46.17% (95%CI 39.18-53.33%), followed by cough (40.15%, 95%CI 34.56-46.02%). Less common symptoms were found to be dyspnea, vomiting, nasal congestion/rhinorrhea, diarrhea, sore throat/pharyngeal congestion, headache, and fatigue. The prevalence of asymptomatic children was 17.19% (95%CI 11.02-25.82%).

The most prevalent laboratory findings in COVID-19 children were elevated Creatinine Kinase (26.86%, 95%CI 16.15-41.19%) and neutropenia (25.76%, 95%CI 13.96-42.58%). These were followed by elevated LDH, thrombocytosis, lymphocytosis, neutrophilia, elevated D Dimer, Elevated CRP, elevated ESR, leukocytosis, elevated AST and leukopenia. There was a low prevalence of elevated ALT and lymphopenia in children with COVID-19.

CONCLUSIONS AND RELEVANCE

This study provides estimates of the pooled prevalence of various symptoms and laboratory findings of COVID-19 in the pediatric population.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.23.20200410: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We conducted an extensive literature search in MEDLINE via PubMed and Ovid Scopus to collect all the relevant articles about clinical characteristics and laboratory findings in COVID-19 positive children from January 1, 2020 to July 15, 2020.
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    The complete results from all databases used for the review were imported into a unique EndNote library upon search completion and 377 duplicated articles were removed.
    EndNote
    suggested: (EndNote, RRID:SCR_014001)

    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:
    However, our study also has several limitations. The majority of the included studies were conducted in China and some studies did not report laboratory findings. Some of the studies also had small sample sizes. We found evidence of publication bias for several of the outcomes. These outcomes tended to have a lower estimated pooled prevalence, and it is possible that some studies did not collect or report data on symptoms they perceived as rare. COVID-19 is characterized by a wide variety of symptoms and our understanding of this has evolved considerably over time. It has taken longer to detect less common symptoms such as gastrointestinal issues like vomiting and diarrhea. Studies with a higher proportion of asymptomatic individuals may have also collected data on fewer symptoms. However, we did not find evidence of publication bias in the majority of symptoms and laboratory findings included in this study. More research studies need to be conducted to determine the possible mechanism of the mild form of COVID-19 disease in children. Further studies also need to be conducted to determine the rate of transmission by COVID-19 children especially asymptomatic children.

    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.

    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.

  2. Version published to 10.1101/2020.09.23.20200410v1 on medRxiv