Pediatr Emerg Care. 2023 Sep 1;39(9):651-653. doi: 10.1097/PEC.0000000000002887. Epub 2022 Dec 21.
Croup due to infection with the omicron variant of COVID is an emerging clinical entity, but distinguishing features of omicron croup have not yet been characterized. We designed a study to compare the clinical features of croup patients presenting to the pediatric emergency department pre-COVID pandemic with COVID-positive croup patients who presented during the initial omicron surge.
This was a retrospective observational cohort study of children 0 to 18 years old who presented to our urban, tertiary care pediatric emergency department with symptoms of croup. The study compared a cohort of croup patients who presented in the year before the onset of the COVID pandemic to a cohort of COVID-positive croup patients who presented during the initial omicron surge. The primary outcomes included illness severity and treatments required in the emergency department. The secondary outcome was hospital admission rate.
There were 499 patients enrolled in the study, 88 in the omicron croup cohort and 411 in the classic croup cohort. Compared with the classic croup patients, omicron croup patients were more likely to present with stridor at rest (45.4% vs 31.4%; odds ratio [OR], 1.82; confidence interval [CI], 1.14-2.91) and hypoxia (3.4% vs 0.5%; OR, 7.22; CI, 1.19-43.86). Omicron croup patients required repeat dosing of inhaled epinephrine in the emergency department more often (20.4% vs 6.8%; OR, 3.51; CI, 1.85-6.70), and they were more likely to require respiratory support (9.1% vs 1.0%; OR, 10.18; CI, 2.99-34.60). Admission rates were significantly higher for omicron croup patients than for classic croup patients (22.7% vs 3.9%; OR, 7.26; CI, 3.58-14.71), and omicron croup patients required intensive care more frequently (5.7% vs 1.5%; OR, 4.07; CI, 1.21-13.64).
Pediatric patients with omicron croup develop more severe disease than do children with classic croup. They are more likely to require additional emergency department treatments and hospital admission than patients with croup before the COVID pandemic.
由 COVID 奥密克戎变异株引起的哮吼是一种新兴的临床实体，但奥密克戎哮吼的特征尚未确定。我们设计了一项研究，以比较 COVID 大流行前在儿科急诊就诊的儿童与在奥密克戎疫情初期出现的 COVID 阳性哮吼儿童的临床特征。
这是一项回顾性观察性队列研究，纳入了在我们的城市三级儿童急诊就诊、有哮吼症状的 0 至 18 岁儿童。该研究比较了在 COVID 大流行前一年就诊的哮吼患儿队列与在奥密克戎疫情初期就诊的 COVID 阳性哮吼患儿队列。主要结局包括急诊科的疾病严重程度和所需的治疗。次要结局是住院率。
共纳入 499 名患儿，奥密克戎哮吼组 88 例，经典哮吼组 411 例。与经典哮吼患儿相比，奥密克戎哮吼患儿更易出现静息时喘鸣（45.4%比 31.4%；比值比 [OR]，1.82；95%置信区间 [CI]，1.14-2.91）和低氧血症（3.4%比 0.5%；OR，7.22；95%CI，1.19-43.86）。奥密克戎哮吼患儿在急诊科更频繁地需要重复吸入肾上腺素治疗（20.4%比 6.8%；OR，3.51；95%CI，1.85-6.70），更可能需要呼吸支持（9.1%比 1.0%；OR，10.18；95%CI，2.99-34.60）。奥密克戎哮吼患儿的住院率明显高于经典哮吼患儿（22.7%比 3.9%；OR，7.26；95%CI，3.58-14.71），且更频繁地需要重症监护（5.7%比 1.5%；OR，4.07；95%CI，1.21-13.64）。
与经典哮吼患儿相比，奥密克戎哮吼患儿的病情更严重。与 COVID 大流行前的哮吼患儿相比，他们更有可能需要额外的急诊科治疗和住院治疗。
