Thirty-Day Outcomes of Children and Adolescents With COVID-19: An International Experience
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Abstract
To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children and adolescents diagnosed or hospitalized with coronavirus disease 2019 (COVID-19) and to compare them in secondary analyses with patients diagnosed with previous seasonal influenza in 2017–2018.
METHODS
International network cohort using real-world data from European primary care records (France, Germany, and Spain), South Korean claims and US claims, and hospital databases. We included children and adolescents diagnosed and/or hospitalized with COVID-19 at age <18 between January and June 2020. We described baseline demographics, comorbidities, symptoms, 30-day in-hospital treatments, and outcomes including hospitalization, pneumonia, acute respiratory distress syndrome, multisystem inflammatory syndrome in children, and death.
RESULTS
A total of 242 158 children and adolescents diagnosed and 9769 hospitalized with COVID-19 and 2 084 180 diagnosed with influenza were studied. Comorbidities including neurodevelopmental disorders, heart disease, and cancer were more common among those hospitalized with versus diagnosed with COVID-19. Dyspnea, bronchiolitis, anosmia, and gastrointestinal symptoms were more common in COVID-19 than influenza. In-hospital prevalent treatments for COVID-19 included repurposed medications (<10%) and adjunctive therapies: systemic corticosteroids (6.8%–7.6%), famotidine (9.0%–28.1%), and antithrombotics such as aspirin (2.0%–21.4%), heparin (2.2%–18.1%), and enoxaparin (2.8%–14.8%). Hospitalization was observed in 0.3% to 1.3% of the cohort diagnosed with COVID-19, with undetectable (n < 5 per database) 30-day fatality. Thirty-day outcomes including pneumonia and hypoxemia were more frequent in COVID-19 than influenza.
CONCLUSIONS
Despite negligible fatality, complications including hospitalization, hypoxemia, and pneumonia were more frequent in children and adolescents with COVID-19 than with influenza. Dyspnea, anosmia, and gastrointestinal symptoms could help differentiate diagnoses. A wide range of medications was used for the inpatient management of pediatric COVID-19.
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SciScore for 10.1101/2020.10.29.20222083: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: All the data partners obtained Institutional Review Board (IRB) approval or exemption to conduct this study, as required. Randomization For the study of medications potentially used for COVID-19, we assessed all medications included in at least two randomized controlled trials [14]. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: This study has some limitations. First, this study is …
SciScore for 10.1101/2020.10.29.20222083: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: All the data partners obtained Institutional Review Board (IRB) approval or exemption to conduct this study, as required. Randomization For the study of medications potentially used for COVID-19, we assessed all medications included in at least two randomized controlled trials [14]. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: This study has some limitations. First, this study is descriptive in nature. The observed differences between groups should therefore not be interpreted as causal effects. Second, our results are based on secondary data from electronic records collected for administrative and clinical management purposes and re-used for research which may affect the completeness of data recorded and may have erroneous entries, leading to potential misclassification. Such incompleteness could be differential in some instances (e.g. hospital vs primary care settings) and risk information bias for the proposed comparisons. Moreover, variability in coding practices and the heterogeneity in healthcare settings inherent to this study may account for some of the observed variability in the prevalence of comorbidities, symptoms and outcomes. Hospital admissions are also variably recorded in the analyzed databases. The under-reporting of symptoms observed in these data is a key finding of this study, and should be taken into consideration in previous and future similar reports from ‘real-world’ cohorts. Our analysis of mortality is similarly subject to differences by database. For example, data on inpatient deaths are more complete while primary care or outpatient death events are typically imported into a given database from a national or local death register. Finally, the currently available data is restricted to the first six months of 2020 coinciding with the peak of the...
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.
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