Department of Emergency Medicine and Trauma Center,
Clinical Trial Office.
Pediatrics. 2020 Dec;146(6). doi: 10.1542/peds.2020-1235. Epub 2020 Sep 23.
Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts.
Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs.
In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases.
Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
在急诊科（ED）中，儿童 2019 年冠状病毒病（COVID-19）的表现存在差异，这对疾病的控制和预防构成挑战。我们描述了一组 170 例 COVID-19 患儿，并与已发表的队列进行了比较。
回顾性分析了 17 家意大利儿科 ED 收治的 170 例儿童患者的病历。
在我们的队列中（中位年龄为 45 个月；四分位间距为 4 个月至 10.7 岁），我们发现有大量年龄<1 岁的 COVID-19 患儿。暴露主要发生在家庭以外的环境中（59%）；22%的患儿合并有合并症。患儿更多表现为无症状（17%）或轻症（63%）。常见症状为咳嗽（43%）和喂养困难（35%）。分别有 2%、36%和 8%的患儿进行了胸部 CT、胸部 X 线和即时肺超声检查。43%的患儿因临床状况入院。CT 和 X 线检查使用率较低可能导致中度病例识别减少，这些病例可能被临床归类为轻症。
在 ED 就诊的意大利儿童症状不明显。对于儿科来说，COVID-19 可能有罕见但严重且危及生命的表现，但在大多数情况下，它对 ED 构成组织负担。这些数据不应降低对 COVID-19 疾病的重视和准备，因为儿童可能是病毒传播的来源。基于临床的分类而不是基于影像学的分类可能更有助于预测患者的需求并更好地分配资源。
