Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
J Hosp Med. 2021 Oct;16(10):603-610. doi: 10.12788/jhm.3689.
Little is known about the clinical factors associated with COVID-19 disease severity in children and adolescents.
We conducted a retrospective cohort study across 45 US children's hospitals between April 2020 to September 2020 of pediatric patients discharged with a primary diagnosis of COVID-19. We assessed factors associated with hospitalization and factors associated with clinical severity (eg, admission to inpatient floor, admission to intensive care unit [ICU], admission to ICU with mechanical ventilation, shock, death) among those hospitalized.
Among 19,976 COVID-19 encounters, 15,913 (79.7%) patients were discharged from the emergency department (ED) and 4063 (20.3%) were hospitalized. The clinical severity distribution among those hospitalized was moderate (3222, 79.3%), severe (431, 11.3%), and very severe (380, 9.4%). Factors associated with hospitalization vs discharge from the ED included private payor insurance (adjusted odds ratio [aOR],1.16; 95% CI, 1.1-1.3), obesity/type 2 diabetes mellitus (type 2 DM) (aOR, 10.4; 95% CI, 8.9-13.3), asthma (aOR, 1.4; 95% CI, 1.3-1.6), cardiovascular disease, (aOR, 5.0; 95% CI, 4.3- 5.8), immunocompromised condition (aOR, 5.9; 95% CI, 5.0-6.7), pulmonary disease (aOR, 5.3; 95% CI, 3.4-8.2), and neurologic disease (aOR, 3.2; 95% CI, 2.7-5.8). Among children and adolescents hospitalized with COVID-19, greater disease severity was associated with Black or other non-White race; age greater than 4 years; and obesity/type 2 DM, cardiovascular, neuromuscular, and pulmonary conditions.
Among children and adolescents presenting to US children's hospital EDs with COVID-19, 20% were hospitalized; of these, 21% received care in the ICU. Older children and adolescents had a lower risk for hospitalization but more severe illness when hospitalized. There were differences in disease severity by race and ethnicity and the presence of selected comorbidities. These factors should be taken into consideration when prioritizing mitigation and vaccination strategies.
关于儿童和青少年 COVID-19 疾病严重程度相关的临床因素知之甚少。
我们对 2020 年 4 月至 2020 年 9 月期间在 45 家美国儿童医院就诊的儿科患者进行了回顾性队列研究，这些患者出院时的主要诊断为 COVID-19。我们评估了与住院相关的因素，以及与临床严重程度相关的因素（例如，住院至住院病房、住院至重症监护病房[ICU]、住院至 ICU 并接受机械通气、休克、死亡）。
在 19976 例 COVID-19 就诊中，15913 例（79.7%）患者从急诊科（ED）出院，4063 例（20.3%）住院。住院患者的临床严重程度分布为中度（3222 例，79.3%）、重度（431 例，11.3%）和极重度（380 例，9.4%）。与从 ED 出院相比，住院的相关因素包括私人支付者保险（调整后的优势比[aOR]，1.16；95%置信区间[CI]，1.1-1.3）、肥胖/2 型糖尿病（aOR，10.4；95% CI，8.9-13.3）、哮喘（aOR，1.4；95% CI，1.3-1.6）、心血管疾病（aOR，5.0；95% CI，4.3-5.8）、免疫功能低下（aOR，5.9；95% CI，5.0-6.7）、肺部疾病（aOR，5.3；95% CI，3.4-8.2）和神经疾病（aOR，3.2；95% CI，2.7-5.8）。在因 COVID-19 住院的儿童和青少年中，更严重的疾病与黑人和其他非白人种族、年龄大于 4 岁、肥胖/2 型糖尿病、心血管、神经肌肉和肺部疾病有关。
在美国儿童医院急诊科就诊的儿童和青少年中，20%的患者住院；其中 21%在 ICU 接受治疗。年龄较大的儿童和青少年住院的风险较低，但住院时病情更严重。疾病严重程度存在种族和民族差异，以及一些合并症的存在。在制定缓解和疫苗接种策略时，应考虑这些因素。
