Liu Vivian Y, Godfrey Madeleine, Dunn Matthew, Fowler Robert, Guthrie Lauren, Dredge David, Holmes Scott, Johnston Alicia M, Simoneau Tregony, Fasano Alessio, Ericson Dawn, Yonker Lael M
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States.
Department of Pediatrics, Harvard Medical School, Boston, MA, United States.
Front Pediatr. 2024 Dec 23;12:1484941. doi: 10.3389/fped.2024.1484941. eCollection 2024.
Given the challenges in diagnosing children with long COVID, we sought to explore diagnostic practices and preferences among clinicians.
A ten-question survey assessed pediatric providers' clinical decision making for identifying and evaluating long COVID in children. Of the 120 survey respondents, 84 (70%) were physicians, 31 (26%) nurse practitioners, and 5 (4%) physician assistants.
The most common categories of symptoms identified as raising suspicion for long COVID in children included cardiopulmonary symptoms, selected by 119 (99%) of pediatric providers, and neurocognitive symptoms, selected by 118 (98%) of providers. However, there was more ambiguity on the primary feature of long COVID, with providers selecting a range of key symptoms. Of all physical exam findings, postural orthostatic tachycardia, was most suggestive of long COVID [identified by 49 (41%) of pediatric providers], whereas one-third of providers reported no specific identifiable exam finding.
Pediatric providers report variable decision making in the clinical evaluation of long COVID, with patient demographics and clinical factors impacting whether a diagnosis of long COVID is considered. This variation in diagnosing pediatric long COVID reflects ambiguity in the definition of long COVID in children and the absence of clinical guidelines to support providers in the identification of disease and treatment. This study highlights an area of need for future clinical advances in pediatric long COVID.
鉴于在诊断患有新冠后遗症的儿童时面临的挑战，我们试图探索临床医生的诊断方法和偏好。
一项包含10个问题的调查评估了儿科医疗人员在识别和评估儿童新冠后遗症方面的临床决策。在120名参与调查的人员中，84名（70%）是医生，31名（26%）是执业护士，5名（4%）是医师助理。
被认为最能引起对儿童新冠后遗症怀疑的常见症状类别包括心肺症状，119名（99%）儿科医疗人员选择了这一症状；还有神经认知症状，118名（98%）医疗人员选择了该症状。然而，关于新冠后遗症的主要特征存在更多的模糊性，医疗人员选择了一系列关键症状。在所有体格检查结果中，体位性直立性心动过速最能提示新冠后遗症[49名（41%）儿科医疗人员识别出该症状]，而三分之一的医疗人员报告没有可明确识别的特定检查结果。
儿科医疗人员报告称，在新冠后遗症的临床评估中决策存在差异，患者人口统计学特征和临床因素会影响是否考虑诊断为新冠后遗症。在诊断儿童新冠后遗症方面的这种差异反映出儿童新冠后遗症定义的模糊性，以及缺乏支持医疗人员识别疾病和进行治疗的临床指南。这项研究突出了儿童新冠后遗症未来临床进展所需的一个领域。
