From the Norton Children's, Louisville, KY.
Department of Pediatrics.
Pediatr Infect Dis J. 2023 Dec 1;42(12):1093-1099. doi: 10.1097/INF.0000000000004081. Epub 2023 Sep 21.
Patient-level data on the clinical features and outcomes of children and young people referred for possible long coronavirus disease (COVID) can guide clinicians on what to expect in managing patients and advising families.
A Post-Acute COVID Clinic for persons <21 years of age was established in October 2020. Intake was standardized and management was tailored to presenting symptoms. Data were abstracted from the charts of all patients evaluated through December 2021, and the study cohort consisted of patients who had a history of confirmed severe acute respiratory syndrome coronavirus 2 infection, had ≥1 symptom persisting for ≥12 weeks and had no pre-existing diagnosis that explained the symptoms. A structured follow-up interview was conducted in early 2022.
A total of 104 patients were referred, 81 of whom met inclusion criteria. The median age was 14 years (interquartile range, 13-16), and most were female, White/Caucasian and had commercial health insurance. Patients reported previously good health but over half reported moderate-to-severe disability at their first visit. Two clusters of presenting symptoms-fatigue with multiple symptoms, and fatigue and headache with cardiopulmonary symptoms-were identified. Extensive routine testing did not affirm alternative diagnoses. Incident conditions-most commonly anxiety, depression and/or panic disorder; migraines; and autonomic dysfunction-were diagnosed on clinical grounds. Telephone interviews (N = 55) revealed that 78% of patients were improved by about 6 months.
Within the limits of a single-center, referral-based, observational cohort, this study provides reassurance to patients and parents in that most cases of long COVID were self-limited. Extensive evaluations may be more useful in ruling out alternative diagnoses than in affirming specific physiologic disturbances.
针对可能患有长期冠状病毒病（COVID）的儿童和青少年的临床特征和结局的患者水平数据可以为临床医生提供管理患者和向家属提供建议的依据。
2020 年 10 月设立了一个针对年龄<21 岁的人急性 COVID 后诊所。通过标准化的接诊流程，根据出现的症状进行针对性治疗。通过对截至 2021 年 12 月所有接受评估的患者的图表进行数据提取，研究队列包括有确诊的严重急性呼吸系统综合征冠状病毒 2 感染史、≥12 周持续存在≥1 个症状且没有可解释症状的预先存在诊断的患者。在 2022 年初进行了结构化的随访访谈。
共转诊了 104 例患者，其中 81 例符合纳入标准。中位年龄为 14 岁（四分位间距，13-16 岁），大多数为女性、白种人/高加索人且有商业健康保险。患者报告之前身体健康，但超过一半的人在首次就诊时报告有中度至重度残疾。出现的症状分为两类-疲劳伴多种症状和疲劳伴头痛及心肺症状，确定了这两类症状。广泛的常规检查并未确认其他诊断。根据临床依据诊断出新发疾病，最常见的是焦虑、抑郁和/或惊恐障碍、偏头痛和自主神经功能障碍。对（N=55）名患者进行电话访谈发现，78%的患者在大约 6 个月时得到改善。
在单中心、基于转诊的观察性队列研究的限制范围内，本研究向患者和家长提供了保证，即大多数长期 COVID 病例都是自限性的。广泛的评估可能更有助于排除其他诊断，而不是确认特定的生理紊乱。
