Correlation of Suspected COVID-19 Symptoms with COVID-19 Positivity in Children

  1. Sanika A. Satoskar
  2. Daniel Hindman
  3. Amyna Husain
  4. Laura Prichett
  5. Oluwakemi B. Badaki
  6. Ann Kane

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Abstract

Background

Early in the pandemic, COVID-19 was found to infect adults at higher rates than children, leaving limited data on disease presentation in children. Further understanding of the epidemiology of COVID-19 symptoms among children is needed. Our aim was to explore how symptoms vary between children testing positive for COVID-19 infection versus children testing negative.

Methods

Data analysis of symptom prevalence among pediatric patients presenting to emergency departments (ED) in the Johns Hopkins Health System (JHHS) with concern for COVID-19 who subsequently received COVID-19 testing. Inclusion criteria included patients 0-17 years-of-age, ED evaluation between March 15th, 2020 - May 11th, 2020, and those who were ordered for COVID-19 testing. Chart review was performed to document symptoms using ED provider notes. Comparisons were made using chi-squared t-tests and Student’s t-tests.

Results

Fever (62.6%) and cough (47.9%) were the most prevalent symptoms among children with suspected COVID-19 infection. Compared to children with a negative COVID-19 test, children who tested positive had higher prevalence of myalgia (21.7% vs 6.0%) and loss of taste/smell (15.2% vs 0.9%). Over half of the children who tested positive for COVID-19 had public insurance (52.2%) and 58.7% of the positive tests occurred among children with Hispanic ethnicity.

Conclusions

Myalgia and loss of taste/smell were found to be significantly more prevalent among COVID-19 positive children compared to children testing negative. Additionally, children with public insurance and those with Hispanic ethnicity were more likely to test positive, emphasizing the importance of social factors in the screening and decision-making process.

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  1. ScreenIT

    SciScore for 10.1101/2022.05.03.22274641: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: This study was approved by the Johns Hopkins University Institutional Review Board (IRB00246826).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We used REDCap for data entry.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    Out of the total 516 patients, 18 patients had missing data for some of the variables and these patients were excluded from the analysis involving those variables. 2.3 Data Analysis: We analyzed data using Microsoft Excel for Mac 2021 and StataIC 16.1 (StataCorp. 2019. Stata Statistical Software:
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    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:
    Our study has several limitations. First, our data contained sampling and ascertainment bias since SARS-CoV-2 testing was based on symptom presentation. We did not test children at random, rather we tested children based on the presence of certain symptoms, which were pre-determined by our testing algorithms at that time. Initially, these symptoms included only fever and respiratory symptoms. Diarrhea and loss of taste/smell were added late in the study period, which likely explains the observed lower prevalence of those symptoms in our study population. Second, we assessed patient encounters that occurred during the early months of the pandemic. Data on COVID-19 symptoms were just beginning to emerge at that time, which may have played a role in symptom documentation and triage. Third, our study was limited to hospitals that are situated in urban settings in a single state, which limits generalizability. Finally, we were not able to assess social and environmental factors such as household structure, parental occupation, and environmental exposures, all of which may influence disease severity and subsequent symptom presentation. As evidence continues to grow, our study provides further insight into COVID-19 symptoms among the pediatric population. However, the presence or absence of any single symptom, other than possibly the sudden loss of taste or smell, is not sufficient to guide clinical decision-making in testing for SARS-CoV-2 among pediatric patients presenting to eme...

    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.

  2. Version published to 10.1101/2022.05.03.22274641v1 on medRxiv