Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020
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Abstract
Very few studies describe factors associated with COVID-19 diagnosis in children.
Aim
We here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy.
Methods
We included cases aged 0–18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19.
Results
Among 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52–90.55; p < 0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19–5.02; p < 0.0001), fever (AOR: 3.05%; 95% CI: 1.67–5.58; p = 0.0003) and anosmia/ageusia (AOR: 4.08; 95% CI: 1.69–9.84; p = 0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered.
Conclusion
Recommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with pre-existing conditions.
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SciScore for 10.1101/2021.03.17.21253610: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data were analyzed with STATA 14 and SAS 9.4. STATAsuggested: (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:Epidemiological data on COVID-19, due also to limitations in the currently available technology for COVID-19 diagnosis (i.e., …
SciScore for 10.1101/2021.03.17.21253610: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data were analyzed with STATA 14 and SAS 9.4. STATAsuggested: (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:Epidemiological data on COVID-19, due also to limitations in the currently available technology for COVID-19 diagnosis (i.e., high rates of false negatives with nasal or nasopharyngeal swabs [45]) may not reflect the real incidence of the disease in each setting, and should, in general, be interpreted with extreme caution. Further studies should document knowledge, attitudes, and practices of case finding and contact tracing in Italy as well as in other settings. More accurate, acceptable, and sustainable tools are also needed for COVID-19 diagnosis. Limitations of this study include the retrospective nature of data, possible selection bias toward more symptomatic cases due to the nature of the network, and the limitation in the technology currently available for COVID-19 diagnosis. Although the use of swabs is currently recommended as the “gold standard” for COVID-19 diagnosis, it has as major limitation of a high percentage of false negative cases [45]. Future studies, when better diagnostic tools will be available, should aim to confirm the observations of the present study. Strengths of this study include its pragmatic and descriptive nature, and the involvement of many pediatric centers in the national territory. More clinical and epidemiological studies are needed to further document the real incidence, presentation, risk factors and outcomes of children with COVID-19 infection in different pediatric subpopulations, to better characterize children at higher risk 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.
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- No protocol registration statement was detected.
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