Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

  1. Russell M Viner
  2. Joseph Lloyd Ward
  3. Lee D Hudson
  4. Melissa Ashe
  5. Sanjay Valabh Patel
  6. Dougal Hargreaves
  7. Elizabeth Whittaker

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Abstract

To undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years.

Design

Narrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020.

Setting

All settings, including hospitalised and community settings.

Patients

Children and young people (CYP) under age 20 years with laboratory-proven COVID-19.

Study review, data extraction and quality

Potentially eligible articles were reviewed on title and abstract by one reviewer. Quality was assessed using the modified AMSTARS criteria and data were extracted from included studies by two reviewers.

Main outcome measures

Prevalence of symptoms and signs of COVID-19.

Results

1325 studies were identified and 18 reviews were included. Eight were high quality, 7 medium and 3 low quality. All reviews were dominated by studies of hospitalised children. The proportion of asymptomatic CYP ranged from 14.6% to 42%. Fever and cough were the the most common symptoms; proportions with fever ranged from 46% to 64.2% and with cough from 32% to 55.9%. All other symptoms or signs including rhinorrhoea, sore throat, headache, fatigue/myalgia and gastrointestinal symptoms including diarrhoea and vomiting were infrequent, occurring in less than 10%–20%.

Conclusions

Fever and cough are the most common symptoms in CYP with COVID-19, with other symptoms infrequent. Further research on symptoms in community samples are needed to inform pragmatic identification and testing programmes for CYP.

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  1. Version published to 10.1136/archdischild-2020-320972
  2. ScreenIT

    SciScore for 10.1101/2020.10.16.20213298: (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
    Search terms in PubMed were (
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    The COVID-19 Living Evidence database (https://zika.ispm.unibe.ch/assets/data/pub/search_beta/) and European PMC (https://europepmc.org) were searched subsequently using similar terms.
    https://europepmc.org
    suggested: (Europe PubMed Central, RRID:SCR_005901)

    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:
    The main limitation of this review is that the great majority of studies in the reviews we examined were of hospitalised children. Whilst early in the pandemic all positive children were hospitalised in some countries regardless of severity, the inclusion of largely hospitalised children is likely to strongly bias these findings towards those with clinical disease and more severe disease. This is likely to inflate the prevalence of symptoms and decrease estimates of the proportion who are asymptomatic. Other studies have suggested that only around 20%31 -50%6 of population samples of CYP have symptoms. Findings from the small number of available community samples suggest that lower proportions present with fever (30%6,32 -40%33) and cough,(10%6 -35%)32,33 consistent with a higher proportion who are asymptomatic. Our findings are subject to a number of other limitations. Some studies were included in multiple reviews in our study. For this reason we did not undertake a meta-summary of findings across reviews. However even in the narrative review undertaken here duplication of studies may still inflate the importance of certain studies compared with others. There was considerable heterogeneity across the included reviews and the risk of publication bias varied by symptom in some reviews. The majority of reviews included data from the early months of the pandemic, and only 3 reviews included studies published after June 2020.13,27,28 This leads to the domination of findings by s...

    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.

  3. Version published to 10.1101/2020.10.16.20213298v1 on medRxiv