Multicenter cohort study of children hospitalized with SARS-CoV-2 infection

Abstract

Background

A cohort study was conducted to describe and compare the characteristics of SARS-CoV-2 infection in hospitalized children in three countries.

Methods

This was a retrospective cohort of consecutive children admitted to 15 hospitals (13 in Canada and one each in Iran and Costa Rica) up to November 16, 2020. Cases were included if they had SARS-CoV-2 infection or multi-system inflammatory syndrome in children (MIS-C) with molecular detection of SARS-CoV-2 or positive SARS-CoV-2 serology.

Results

Of 211 included cases (Canada N=95; Costa Rica N=84; Iran N=32), 103 (49%) had a presumptive diagnosis of COVID-19 or MIS-C at admission while 108 (51%) were admitted with other diagnoses. Twenty-one (10%) of 211 met criteria for MIS-C. Eighty-seven (41%) had comorbidities. Children admitted in Canada were older than those admitted to non-Canadian sites (median 4.1 versus 2.2 years; p<0.001) and less likely to require mechanical ventilation (3/95 [3%] versus 15/116 [13%]; p<0.05). Sixty-four of 211 (30%) required supplemental oxygen or intensive care unit (ICU) admission and 4 (1.9%) died. Age < 30 days, admission outside Canada, presence of at least one comorbidity and chest imaging compatible with COVID-19 predicted severe or critical COVID-19 (defined as death or need for supplemental oxygen or ICU admission).

Conclusions

Approximately half of hospitalized children with confirmed SARS-CoV-2 infection or MIS-C were admitted with other suspected diagnoses. Disease severity was higher at non-Canadian sites. Neonates, children with comorbidities and those with chest radiographs compatible with COVID-19 were at increased risk for severe or critical COVID-19.

Main points

Approximately half of hospitalized children with laboratory confirmed MIS-C or SARS-CoV-2 infection were admitted with another primary diagnoses. The severity of disease was higher in the middle income countries (Costa Rica and Iran) than in Canada.

SciScore for 10.1101/2021.02.19.21251340: (What is this?)

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

Table 1: Rigor

Institutional Review Board Statement	IRB: Ethics approval was obtained from the following ethics review boards: Comité Ético Científico Hospital Nacional de Niños, San José, Costa Rica (CEC-HNN-030-2020), Iran University of Medical Sciences Ethics Review Committee (IR.IUMS.REC.1399.187), The Hospital for Sick Children Research Ethics Board (#1000070091), Pediatric Panel of the Research Ethics Board of the Research Institute of the McGill University Health Centre (#MP-37-2021-6561), Conjoint Health Research Ethics Board, University of Calgary (REB20-0594), Children’s Hospital of Eastern Ontario Research Ethics Board (CHEOREB# 20/32X), University of British Columbia Children’s and Women’s Research Ethics Board (# H20-00977), Health Research Ethics Board, University of Manitoba (HSC23858), University of Saskatchewan Biomedical Research Ethics Board (Study 1921), Hamilton Integrated Research Ethics Board, Centre Hospitalier Universitaire de Québec-Université Laval (37-2021-6561), and Health Research Ethics Board, University of Alberta (Pro00099426).
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	not detected.

Table 2: Resources

Software and Algorithms
Sentences	Resources
Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Alberta.	REDCap suggested: (REDCap, RRID:SCR_003445)

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:

This study has the inherent limitations of a retrospective chart review. It was not population based as most participating hospitals are referral centers so milder cases might have been admitted elsewhere. Indications for testing for SARS-CoV-2 and available assays varied by center. We were not able to account for the severity of comorbidities. Interpretation of chest radiographs was not standardized. Prior studies suggest that Black and Latin American children are at increased risk of COVID-19 [22] and of MIS-C [21] but race or ethnic background were not available in our cohort. MIS-C cases are under-reported as i) MIS-C was yet to be described when the study commenced so relevant clinical questions were not included in the original version of the case report form and ii) SARS-CoV-2 serology was not available at any sites early in the study and remained unavailable by the end of the study at some sites. In conclusion, approximately half of children with SARS-CoV-2 infection or MIS-C diagnosed during hospitalization were admitted with another diagnosis. Clinicians must consider the diagnosis of community-acquired or healthcare-associated SARS-CoV-2 infection in all admitted children. Neonates, children with comorbidities and those with a chest radiograph compatible with COVID-19 were at highest risk of requiring supplemental oxygen or ICU admission during SARS-CoV-2 hospitalization. Death was rare, but children with malignancies appear to be over-represented. Future studies a...

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.

Read the original source