Persistence of neuropsychiatric symptoms associated with SARS-CoV-2 positivity among a cohort of children and adolescents
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Abstract
Background
Post-acute sequelae of COVID-19 are common among adults. The prevalence of such syndromes among community samples of children and adolescents remains less well characterized.
Method
We identified all individuals age 5-18 across 2 New England health systems who had a positive SARS-CoV-2 PCR test between 3/12/2020 and 4/18/2021 and at least 90 days of follow-up visits documented in electronic health records. We identified neuropsychiatric symptoms in intervals prior to, and following, this testing using a previously-derived set of ICD-10 codes and natural language processing terms. Primary analysis examined sociodemographic features associated with presence of at least one incident (i.e., new-onset) neuropsychiatric symptom between 90 and 150 days after an initial positive test for COVID-19.
Results
Among 5058 children (50% female, 2.9% Asian, 6.3% Black, and 63% White; 30% Hispanic; mean age was 12.4 (IQR 8.9-15.6), 366 (7.2%) exhibited at least one new-onset neuropsychiatric symptom between 90 and 150 days following initial SARS-CoV-2 test positivity. The most common incident symptoms at 90-150 days were headache (2.4%), mood and anxiety symptoms (2.4%), cognitive symptoms (2.3%), and fatigue (1.1%). In regression models, older children, girls, those with Hispanic ethnicity, those with public versus private insurance, and those with greater overall burden of medical comorbidity were more likely to exhibit subsequent symptoms.
Conclusion
The prevalence of neuropsychiatric symptoms between 3- and 5-months following SARS-CoV-2 test positivity is similar to that observed in the period prior to infection. Prospective controlled studies will be needed to further refine these estimates.
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SciScore for 10.1101/2021.09.28.21264259: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: The Human Research Committee of Mass General-Brigham granted a waiver of informed consent requirement for this research protocol under 45 CFR 46.116, as only secondary use of data generated by routine clinical care was required. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
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:On the other hand, capture of …
SciScore for 10.1101/2021.09.28.21264259: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: The Human Research Committee of Mass General-Brigham granted a waiver of informed consent requirement for this research protocol under 45 CFR 46.116, as only secondary use of data generated by routine clinical care was required. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
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:On the other hand, capture of outcomes is less reliable than that afforded by prospective cohort studies, even though both designs pose limitations as participants are not uniformly observed and data are not missing at random. We present analyses of concomitant medications as a means of understanding potential risk factors for persistence of neuropsychiatric symptoms, but such results must be interpreted with caution. Some of these likely represent markers of preexisting neuropsychiatric symptoms – for example, guanfacine and clonidine are often used in children for treatment of attention deficit-hyperactivity disorder, and escitalopram for depression or anxiety. Others may indicate more severe acute illness, including dexamethasone, or treatment of comorbidity during COVID-19 illness, such as metronidazole. More broadly, all such data underscore that electronic health records reflect patterns of clinical service, not regular systematic assessment – so, for example, individuals with closer follow-up for other reasons may be more likely to have neuropsychiatric symptoms documented. (For further consideration of the impact of missing data in electronic health records, see Haneuse[23]). While not a focus of this effort, the likelihood of residual confounding highlights the limitations of efforts to identify medications with off-target effects for repositioning. Despite these challenges, more precise estimates of prevalence will be important in facilitating conversations about ri...
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.
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