Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
BMC Pediatr. 2021 Sep 13;21(1):403. doi: 10.1186/s12887-021-02863-1.
The spectrum of illness and predictors of severity among children with SARS-CoV-2 infection are incompletely understood.
Active surveillance was performed for SARS-CoV-2 by polymerase chain reaction among symptomatic pediatric patients in a quaternary care academic hospital laboratory beginning March 12, 2020. We obtained sociodemographic and clinical data 5 (+/-3) and 30 days after diagnosis via phone follow-up and medical record review. Logistic regression was used to assess predictors of hospitalization.
The first 1000 symptomatic pediatric patients were diagnosed in our institution between March 13, 2020 and September 28, 2020. Cough (52 %), headache (43 %), and sore throat (36 %) were the most common symptoms. Forty-one (4 %) were hospitalized; 8 required ICU admission, and 2 required mechanical ventilation (< 1 %). One patient developed multisystem inflammatory syndrome in children; one death was possibly associated with SARS-CoV-2 infection. Symptom resolution occurred by follow-up day 5 in 398/892 (45 %) patients and by day 30 in 443/471 (94 %) patients. Pre-existing medical condition (OR 7.7; 95 % CI 3.9-16.0), dyspnea (OR 6.8; 95 % CI 3.2-14.1), Black race or Hispanic ethnicity (OR 2.7; 95 % CI 1.3-5.5), and vomiting (OR 5.4; 95 % CI 1.2-20.6) were the strongest predictors of hospitalization. The model displayed excellent discriminative ability (AUC = 0.82, 95 % CI 0.76-0.88, Brier score = 0.03).
In 1000 pediatric patients with systematic follow-up, most SARS-CoV-2 infections were mild, brief, and rarely required hospitalization. Pediatric predictors of hospitalization included comorbid conditions, Black race, Hispanic ethnicity, dyspnea and vomiting and were distinct from those reported among adults.
儿童 SARS-CoV-2 感染的疾病谱和严重程度的预测因素尚不完全清楚。
自 2020 年 3 月 12 日起，在一家四级保健学术医院实验室，通过聚合酶链反应对有症状的儿科患者进行 SARS-CoV-2 的主动监测。我们通过电话随访和病历回顾，在诊断后 5(+/-3)天和 30 天获取社会人口统计学和临床数据。使用逻辑回归评估住院的预测因素。
2020 年 3 月 13 日至 2020 年 9 月 28 日，我院共诊断出 1000 例首例有症状的儿科患者。最常见的症状是咳嗽(52%)、头痛(43%)和喉咙痛(36%)。41 例(4%)住院治疗；8 例需要 ICU 入院，2 例需要机械通气(<1%)。1 例患者发生儿童多系统炎症综合征；1 例死亡可能与 SARS-CoV-2 感染有关。在 892 例有症状的患者中，398 例(45%)在随访第 5 天症状缓解，471 例中有 443 例(94%)在第 30 天症状缓解。存在基础疾病(OR 7.7；95%CI 3.9-16.0)、呼吸困难(OR 6.8；95%CI 3.2-14.1)、黑种人或西班牙裔(OR 2.7；95%CI 1.3-5.5)和呕吐(OR 5.4；95%CI 1.2-20.6)是住院的最强预测因素。该模型具有良好的区分能力(AUC=0.82，95%CI 0.76-0.88，Brier 评分=0.03)。
在 1000 例有系统随访的儿科患者中，大多数 SARS-CoV-2 感染为轻度、短暂，很少需要住院治疗。住院的儿科预测因素包括合并症、黑种人、西班牙裔、呼吸困难和呕吐，与成人报道的预测因素不同。
