A Comprehensive Clinical Description of Pediatric SARS-CoV-2 Infection in Western Pennsylvania

  1. Megan Culler Freeman
  2. Kristina Gaietto
  3. Leigh Anne DiCicco
  4. Sherry Rauenswinter
  5. Joseph R Squire
  6. Zachary Aldewereld
  7. Glenn Rapsinski
  8. Jennifer Iagnemma
  9. Brian T. Campfield
  10. David Wolfson
  11. Traci M. Kazmerski
  12. Erick Forno

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Objective: We sought to characterize clinical presentation and healthcare utilization for pediatric COVID-19 in Western Pennsylvania (PA). Methods: We established and analyzed a registry of pediatric COVID-19 in Western PA that includes cases in patients <22 years of age cared for by the pediatric quaternary medical center in the area and its associated pediatric primary care network from March 11 through August 20, 2020. Results: Our cohort included 424 pediatric COVID-19 cases (mean age 12.5 years, 47.4% female); 65% reported exposure and 79% presented with symptoms. The most common initial healthcare contact was through telehealth (45%). Most cases were followed as outpatients, but twenty-two patients (4.5%) were hospitalized: 19 with acute COVID-19 disease, and three for multisystem inflammatory syndrome of children (MIS-C). Admitted patients were younger (p<0.001) and more likely to have pre-existing conditions (p<0.001). Black/Hispanic patients were 5.8 times more likely to be hospitalized than white patients (p=0.012). Five patients (1.2%) were admitted to the PICU, including all three MIS-C cases; two required BiPAP and one mechanical ventilation. All patients survived. Conclusions: We provide a comprehensive snapshot of pediatric COVID-19 disease in an area with low to moderate incidence. In this cohort, COVID-19 was generally a mild disease; however, ~5% of children were hospitalized. Pediatric patients can be critically ill with this infection, including those presenting with MIS-C.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.12.14.20248192: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Patient information was securely handled as approved by the institutional review board at the University of Pittsburgh (Protocol # STUDY20030250).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Case Inclusion and Data Extraction: At the outset of the pandemic in the region, we created the Western PA Pediatric COVID-19 Registry as a secure RedCap database with the goal of adding cases as they arise during the pandemic and following their course over time15 The registry includes all positive SARS-CoV-2 cases under 22 years of age seen at CHP or at CCP via active surveillance since the first reported case in the region; for this analysis, we included cases through August 20, 2020, as this was prior to return-to-school in the region.
    RedCap
    suggested: (REDCap, RRID:SCR_003445)
    We utilized GraphPad Prism (version 8.0; GraphPad) and STATA v16 (StataCorp LLC) to conduct analyses and used packages choroplethr and choroplethrZip in R v4.0.2 / RStudio v1.3.1073 to produce the choropleth maps.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)
    RStudio
    suggested: (RStudio, RRID:SCR_000432)

    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:
    At the same time, we must acknowledge study limitations. First, given the scope of practice at our referral center, we cannot rule out bias towards more severe disease; however, most cases were detected and followed as outpatients at CCP. Second, the current report does not yet include long-term patient outcomes and, thus, these data provide a limited understanding of patient recovery or long-term sequelae. However, this real-time registry will allow for additional follow-up on these metrics. We can use this tool to measure how dynamics of the outbreak in the pediatric population change with added factors in the coming months, including changes in child behavior with the school year, the respiratory virus season, and hopefully the eventual introduction of vaccines. In summary, this report provides a comprehensive overview of the breadth of presentation of pediatric infection with SARS-CoV-2 in a single geographic area. In general, pediatric patients tolerate this infection well, with only a small proportion (∼5%) requiring hospital admission, and even fewer (∼1.2%) presenting with critical illness. Large, multicenter collaborative efforts will be crucial to better understand factors associated with severe pediatric SARS-CoV-2 disease, particularly in racial and ethnic minorities at higher risk.

    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 10.1101/2020.12.14.20248192v1 on medRxiv