Alberta Strategy for Patient Oriented Research Support Unit Data Platform and Provincial Research Data Services (King, Whitten), Alberta Health Services, Calgary Alta.; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (Bakal, McAlister) and Provincial Research Data Services (Bakal), Alberta Health Services, Edmonton, Alta.; Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alta.
CMAJ. 2021 Jan 4;193(1):E1-E9. doi: 10.1503/cmaj.202065. Epub 2020 Nov 24.
Research involving children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has primarily focused on those presenting to emergency departments. We aimed to determine the symptoms most commonly associated with a positive result for a SARS-CoV-2 swab among community-based children.
We conducted an observational study among children tested and followed for SARS-CoV-2 infection using nasal, nasopharyngeal, throat or other (e.g., nasopharyngeal aspirate or tracheal secretions, or unknown) swabs between Apr. 13 and Sept. 30, 2020, in Alberta. We calculated positive likelihood ratios (LRs) for self-reported symptoms and a positive SARS-CoV-2 swab result in the entire cohort and in 3 sensitivity analyses: all children with at least 1 symptom, all children tested because of contact tracing whether they were symptomatic or not and all children 5 years of age or older.
We analyzed results for 2463 children who underwent testing for SARS-CoV-2 infection; 1987 children had a positive result and 476 had a negative result. Of children with a positive test result for SARS-CoV-2, 714 (35.9%) reported being asymptomatic. Although cough (24.5%) and rhinorrhea (19.3%) were 2 of the most common symptoms among children with SARS-CoV-2 infection, they were also common among those with negative test results and were not predictive of a positive test (positive LR 0.96, 95% confidence interval [CI] 0.81-1.14, and 0.87, 95% CI 0.72-1.06, respectively). Anosmia/ageusia (positive LR 7.33, 95% CI 3.03-17.76), nausea/vomiting (positive LR 5.51, 95% CI 1.74-17.43), headache (positive LR 2.49, 95% CI 1.74- 3.57) and fever (positive LR 1.68, 95% CI 1.34-2.11) were the symptoms most predictive of a positive result for a SARS-CoV-2 swab. The positive LR for the combination of anosmia/ageusia, nausea/vomiting and headache was 65.92 (95% CI 49.48-91.92).
About two-thirds of the children who tested positive for SARS-CoV-2 infection reported symptoms. The symptoms most strongly associated with a positive SARS-CoV-2 swab result were anosmia/ageusia, nausea/vomiting, headache and fever.
涉及严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染儿童的研究主要集中在急诊科就诊的患儿。我们旨在确定在社区中进行 SARS-CoV-2 拭子检测的患儿中，最常与 SARS-CoV-2 拭子阳性结果相关的症状。
我们在 2020 年 4 月 13 日至 9 月 30 日期间，对在艾伯塔省接受 SARS-CoV-2 感染检测和随访的患儿进行了一项观察性研究，检测方法为鼻、鼻咽、咽或其他部位（如鼻咽抽吸物或气管分泌物，或未知部位）拭子。我们计算了整个队列中和 3 项敏感性分析中，自我报告症状和 SARS-CoV-2 拭子阳性结果之间的阳性似然比（LR）：至少有 1 种症状的所有患儿、因接触者追踪而接受检测的无论有无症状的所有患儿以及所有 5 岁及以上的患儿。
我们分析了 2463 名接受 SARS-CoV-2 感染检测的患儿的检测结果；1987 名患儿的检测结果为阳性，476 名患儿的检测结果为阴性。在 SARS-CoV-2 检测结果为阳性的患儿中，714 名（35.9%）患儿报告无症状。虽然咳嗽（24.5%）和流涕（19.3%）是 SARS-CoV-2 感染患儿的 2 种最常见症状，但它们在检测结果为阴性的患儿中也很常见，且不能预测检测结果为阳性（阳性 LR 0.96，95%CI 0.81-1.14，和 0.87，95%CI 0.72-1.06）。嗅觉丧失/味觉障碍（阳性 LR 7.33，95%CI 3.03-17.76）、恶心/呕吐（阳性 LR 5.51，95%CI 1.74-17.43）、头痛（阳性 LR 2.49，95%CI 1.74-3.57）和发热（阳性 LR 1.68，95%CI 1.34-2.11）是与 SARS-CoV-2 拭子阳性结果最相关的症状。嗅觉丧失/味觉障碍、恶心/呕吐和头痛联合的阳性 LR 为 65.92（95%CI 49.48-91.92）。
约三分之二 SARS-CoV-2 检测呈阳性的患儿报告有症状。与 SARS-CoV-2 拭子阳性结果最密切相关的症状是嗅觉丧失/味觉障碍、恶心/呕吐、头痛和发热。
