Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA.
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Pediatr Res. 2022 Feb;91(3):494-501. doi: 10.1038/s41390-020-01161-3. Epub 2020 Sep 17.
There are sparse patient-level data available for children with novel coronavirus disease (COVID-19). Therefore, there is an urgent need for an updated systematic literature review that analyzes individual children rather than aggregated data in broad age groups.
Six databases (MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, medRxiv) were searched for studies indexed from January 1 to May 15, 2020, with MeSH terms: children, pediatrics, COVID-19, SARS-CoV-2. 1241 records were identified, of which only unique papers in English with individual patient information and documented COVID-19 testing were included. This review of 22 eligible studies followed Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data guidelines.
A total of 123 patients from five countries were identified. 46% were females. The median age was 5 years (IQR = 8). At presentation, 62% had a fever, 32% had a cough, 58% had a single symptom, and 21% were asymptomatic. Abnormal chest imaging was seen in 62% (65/105) of imaged and 76.9% (20/26) of asymptomatic children. A minority of children had elevated platelets, CRP, lactate dehydrogenase, and D-dimer.
Data from this independent participant data systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom.
This systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom. By using an independent participant data approach, this analysis underscores the challenge of diagnosing COVID-19 in pediatric patients due to the wide variety of symptoms and seemingly poor correlation of imaging findings with symptomatic disease. The data presented from individual patients from case series or cohort studies add more granularity to the current description of pediatric COVID-19.
目前仅有少量关于新型冠状病毒病（COVID-19）患儿的患者水平数据。因此，非常有必要进行更新的系统文献综述，分析个体患儿，而不是对广泛年龄组的汇总数据进行分析。
检索了 MEDLINE、Scopus、Web of Science、CINAHL、Google Scholar 和 medRxiv 数据库，以查找 2020 年 1 月 1 日至 5 月 15 日收录的索引研究，使用的 MeSH 术语为儿童、儿科学、COVID-19、SARS-CoV-2。共鉴定了 1241 份记录，仅纳入了具有个体患者信息和记录的 COVID-19 检测结果且为英文的独特论文。对 22 项符合条件的研究进行了综述，遵循了个体参与者数据系统评价和荟萃分析的首选报告项目指南。
共确定了来自五个国家的 123 名患者。女性占 46%。中位年龄为 5 岁（IQR=8）。就诊时，62%有发热，32%有咳嗽，58%有单一症状，21%无症状。有影像学检查的患儿中 62%（65/105）有异常胸部影像学表现，无症状患儿中 76.9%（20/26）有异常胸部影像学表现。少数患儿的血小板、C 反应蛋白、乳酸脱氢酶和 D-二聚体升高。
本独立参与者数据系统综述的数据表明，大多数 COVID-19 患儿表现为无症状或仅有单一非呼吸道症状。
本系统综述表明，大多数 COVID-19 患儿表现为无症状或仅有单一非呼吸道症状。通过使用独立参与者数据方法，本分析强调了由于症状多种多样，影像学发现与症状性疾病相关性差，因此在儿科患者中诊断 COVID-19 具有挑战性。来自病例系列或队列研究的个体患者数据为当前对儿科 COVID-19 的描述提供了更多的细节。
