Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments The Global PERN-COVID-19 Study

• Type of Material: Article
• Authors: Anna L Funk, University of Calgary; Todd A Florin, Northwestern University; Nathan Kuppermann, University of California Davis; Daniel J Tancredi, University of California Davis; Jianling Xie, University of Calgary; Kelly Kim, University of Calgary; Mark Neuman, Harvard Medical School; Lilliam Ambroggio, University of Colorado, Aurora; Amy C Plint, University of Ottawa; Santiago Mintegi, University of Basque Country; Terry P Klassen, University of Manitoba; Marina Salvadori, Public Health Agency of Canada; Richard Malley, Harvard Medical School; Daniel C Payne, Centers for Disease Control and Prevention; Norma-Jean Simon, Ann and Robert H. Lurie Children’s Hospital of Chicago; Adriana Yock-Corrales, Hospital Nacional de Niños “Dr Carlos Sáenz Herrera”; Jasmine R Nebhrajani, St Mary’s Medical Center; Pradip P Chaudhari, Children’s Hospital Los Angeles; Kristen A Breslin, Children’s National Hospital; Yaron Finkelstein, Hospital for Sick Children; Carmen Campos, Hospital Universitario Miguel Servet; Kelly R Bergmann, Children’s Minnesota, Minneapolis; Maala Bhatt, Children’s Hospital of Eastern Ontario; Fahd A Ahmad, Washington University School of Medicine; Michael A Gardiner, University of California San Diego; Usha R Avva, Sch Med Hackensack Meridian Hlth; Nipam P Shah, University of Alabama Birmingham; Laura F Sartori, Childrens Hospital of Philadelphia; Vikram J Sabhaney, University of British Columbia; Kerry Caperell, University of Louisville; Nidya Navanandan, University of Colorado; Meredith L Borland, Perth Children’s Hospital; Claudia Morris, Emory University; Iker Gangoiti, University of Basque Country; Viviana Pavlicich, Universidad Privada del Pacífico; Nirupama Kannikeswaran, Central Michigan University; Maren M Lunoe, UPMC Childrens Hosp Pittsburgh; Pedro B Rino, Hosp Pediat Prof Dr Juan P Garrahan; April J Kam, McMaster Children’s Hospital, Hamilton; Jonathan C Cherry, Dalhousie University; Alexander J Rogers, University of Michigan; Shu-Ling Chong, Duke-NUS Medical School; Laura Palumbo, ASST Spedali Civili Brescia Pronto Soccorso Pedia; Carlos M Angelats, Hospital Francesc de Borja; Andrea K Morrison, Medical College of Wisconsin; Maria Y Kwok, Columbia Univ Irving Med Ctr; Sarah M Becker, University of Utah; Andrew C Dixon, University of Alberta; Naveen Poonai, Schulich School of Medicine & Dentistry; Michelle Eckerle, University of Cincinnati; Muhammad Wassem, Lincoln Medical Center; Stuart R Dalziel, Starship Children’s Hospital; Stephen B Freedman, University of Calgary
• Language: English
• Date: 2022-01-11
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2022 Funk AL et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2021.42322
• Title of Journal or Parent Work: JAMA NETWORK OPEN
• Volume: 5
• Issue: 1
• Start Page: e2142322
• End Page: e2142322
• Grant/Funding Information: This study was supported by grants from the Canadian Institutes of Health Research (Operating Grant: COVID-19 – Clinical management), Alberta Innovates, the Alberta Health Services – 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 Funk was supported by the University of Calgary Eyes-High Post-Doctoral Research Fund. Dr Freedman was supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness.
• Keywords: Medicine, General & Internal; CHILDREN; General & Internal Medicine; RISK-FACTORS; COVID-19; Life Sciences & Biomedicine; Science & Technology
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Importance: Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. Objective: To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). Design, Setting, and Participants: This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. Exposures: Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. Main Outcomes and Measures: Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. Results: Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). Conclusions and Relevance: In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.