11 Jan Pediatric COVID: Teenagers Most at Risk of Severe Outcomes
MedicalResearch.com Interview with:
Stephen Freedman MDCM, MSc
Professor of Pediatrics and Emergency Medicine
Alberta Children’s Hospital Foundation Professor in Child Health and Wellness
Alberta Children’s Hospital Research Institute, Cumming School of Medicine
University of Calgary
MedicalResearch.com: What is the background for this study?
Response: During the early stages of the global 2019 coronavirus disease (COVID-19) pandemic, children represented fewer than 5% of reported cases. However, children now represent a significant percent of all new COVID-19 cases. Similarly, pediatric hospitalizations due to COVID-19, are now at an all-time high. Although COVID-19 is generally mild in children, severe outcomes and death do occur. The risk of severe outcomes among SARS-CoV-2 infected children is poorly understood with estimates varying considerably between study designs, settings, and regions. Studies generally include large administrative databases (i.e. community based), hospitalized populations, and children admitted to the intensive care unit (ICU).
Identified risk factors for severe COVID-19 in children have included young (i.e. 1-3 months) or old (15-18 years) pediatric age group, male sex, and pre-existing medical condition. However, data from large prospective cohort studies which include children with early or mild stages of disease seeking emergency department (ED) care are lacking.
To address this knowledge gap we sought to quantify the frequency of and risk factors for severe outcomes in SARS-CoV-2 infected children enrolled in a prospective ED-based cohort study.
MedicalResearch.com: What are the main findings?
Response: Among 3221 SARS-CoV-2 positive children enrolled in a global prospective cohort study with outcome data, 107 (3.3%) had a severe outcome within 14 days. Across a subgroup of 2510 SARS-CoV-2 positive children discharged home after testing, 12 (0.5%) had a severe outcome during the two-week follow-up period. We identified the following risk factors for severe outcomes: age 5 to <10 years and 10 to <18 years, having a pre-existing chronic illness, previous episode of pneumonia, and presenting to the hospital 4 to 7 days after symptom onset. Among children from the United States, similar risk factors were identified; and race and ethnicity were not associated with severe outcomes. Additionally, the risk of a severe outcome was higher among hospitalized SARS-CoV-2 positive children compared with similar children who were hospitalized whose SARS-CoV-2 test was negative.
MedicalResearch.com: What should readers take away from your report?
Response: This article primarily provides information relevant to health care providers. But the messages of importance for the general public include:
1) If children are sick enough to need to be hospitalized, some do experience severe outcomes.
2) Those at greatest risk of severe outcomes are older children – notably teenagers, those who become progressively unwell between 4-7 days after symptoms develop, those with significant underlying diseases.
3) Among hospitalized children, those infected by SARS-CoV-2 are more likely to have a severe outcome than otherwise similar children whose SARS-CoV-2 test was negative.
4) If children do not need to be hospitalized then the risk of a severe outcome is very low.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It would ideal to further evaluate laboratory predictors of severe outcomes, which when incorporated with clinical characteristics could be used to derive risk prediction models to identify those at greatest risk for severe outcomes.
MedicalResearch.com: Is there anything else you would like to add?
Response: The authors have no conflicts of interest to disclose.
This study was supported by grants from the Canadian Institutes of Health Research (Operating Grant: COVID-19 – Clinical management, the Alberta Health Service – University of Calgary – Clinical Research Fund, the Alberta Children’s Hospital Research Institute, the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California, Davis, and the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grants Program. Dr. Anna Funk, is supported by the University of Calgary Eyes-High Post-Doctoral Research Fund. Dr. Stephen Freedman is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness.
Funk AL, Florin TA, Kuppermann N, et al. Outcomes of SARS-CoV-2–Positive Youths Tested in Emergency Departments: The Global PERN–COVID-19 Study. JAMA Netw Open. 2022;5(1):e2142322. doi:10.1001/jamanetworkopen.2021.42322
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