Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases
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Abstract
Background
This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death.
Methods
An observational longitudinal study was conducted during the first year of the SARS-CoV-2 pandemic (March 2020–March 2021). All pediatric patients attended at the rheumatology outpatient clinics of six tertiary referral hospitals in Madrid, Spain, with a diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic and clinical characteristics and treatment regimens. We ran a multivariable logistic regression model to assess associated factors for outcomes.
Results
The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients (38.96%) were asymptomatic, 41 (53.25%) had a mild-moderate COVID-19 and 6 patients (7.79%) required hospital admission. The median length of hospital admission was 5 (2–20) days, one patient required intensive care and there were no deaths. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was previous use of glucocorticoids (OR 3.51; p = 0.00). No statistically significant risk factors for symptomatic COVID-19 were found in the final model.
Conclusion
No differences in COVID-19 outcomes according to childhood-onset rheumatic disease types were found. Results suggest that associated comorbidities and treatment with glucocorticoids increase the risk of hospital admission.
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SciScore for 10.1101/2021.05.19.21257450: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IACUC: The study was approved by the Hospital Ramon y Cajal Institutional Ethics Committee (approval number 136-20). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources The inclusion criteria were age <18 years, a medical diagnosis (according to ICD-10) of a pediatric RMD, and COVID-19 disease confirmed with a positive SARS-CoV-2 polymerase chain reaction (PCR) test, positive rapid antigen test or detection of antibodies against SARS-CoV-2, or clinical diagnosis based on typical symptoms and epidemiological data during the first weeks of the pandemic, due to the lack of widely … SciScore for 10.1101/2021.05.19.21257450: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IACUC: The study was approved by the Hospital Ramon y Cajal Institutional Ethics Committee (approval number 136-20). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources The inclusion criteria were age <18 years, a medical diagnosis (according to ICD-10) of a pediatric RMD, and COVID-19 disease confirmed with a positive SARS-CoV-2 polymerase chain reaction (PCR) test, positive rapid antigen test or detection of antibodies against SARS-CoV-2, or clinical diagnosis based on typical symptoms and epidemiological data during the first weeks of the pandemic, due to the lack of widely available diagnostic tests. SARS-CoV-2suggested: NoneSoftware and Algorithms Sentences Resources Study data were collected and managed using REDCap electronic data capture tools hosted at SORCOM. REDCapsuggested: (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:Despite these strengths, there are important limitations to these registry data. The COVID-SORCOM registry is voluntary and does not capture all cases of COVID-19 in pediatric patients with RMD. This approach to data collection places limitations on causal conclusions and temporal relationships and therefore we can only make limited inferences based on our results. Due to the database design and inherent reporting bias the data cannot be used to comment on the incidence of COVID-19 in this patient population. The limited size of the sample makes it a descriptive study with exploratory analyzes, but still gives us detailed information about this population, and brings us closer to preliminary results that are in line with what has been published in the adult population with RMD, helping to make decision-making and patient monitoring. Although further studies are required, children with RMD or receiving immunomodulatory therapies don’t seem to have a higher risk for severe COVID-19 and preventive measures are similar to those counseled to the general population(23)(21). In conclusion, overall outcomes in children and adolescents with RMD appear to be generally good, with mild infection. However, we should keep in mind that children are not immune to COVID-19, and although rarely, the disease could be severe and complicated. Comorbidities and the use of glucocorticoids could be considered as risk factors in the RMD pediatric population as well as in adults. These factors could h...
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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