Characteristics and risk factors associated with critical illness in pediatric COVID-19

INTRODUCTION: Little is known regarding the course and severity of pediatric COVID-19. We describe critical illness in pediatric patients with PCR+ SARS-CoV2 infection and identify factors associated with PICU admission and organ dysfunction. METHODS: This is a retrospective chart review of 77 pediatric patients age 1 day to 21 years admitted to two New York City pediatric hospitals within the Northwell Health system between February 1 and April 24, 2020 with PCR+ SARS-CoV-2. Descriptive statistics were used to describe the hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. RESULTS: Forty-seven patients (61%) were admitted to the general pediatric floor and thirty (39%) to the PICU. The majority (97%, n=68) survived to discharge, 1.3% (n=1) remain admitted, and one (1.3%) died. Of PICU patients, 46.7% experienced significant organ dysfunction (pSOFA>=2) during admission. Patients aged 12 years or greater were more likely to be admitted to a PICU compared to younger patients (p=0.015). Presence of an underlying comorbidity was not associated with need for PICU admission (p=0.23) or organ dysfunction (p=0.87). Initial white blood cell count (WBC), platelet count, and ferritin were not associated with need for PICU admission. Initial C-reactive protein was associated with both need for PICU admission (p=0.005) and presence of organ dysfunction (p=0.001). Initial WBC was associated with organ dysfunction (p=0.034). Presenting thrombocytopenia was associated with organ dysfunction (p=0.003). Common indications for PICU admission included hypoxia (50%), hemodynamic instability (20%), diabetic ketoacidosis (6.7%), mediastinal mass (6.7%), apnea (6.7%), acute chest syndrome (6.7%), and cardiac dysfunction (6.7%). CONCLUSIONS: Need for PICU admission in COVID-19 was associated with age over 12 years and elevated initial CRP. Organ dysfunction was associated with elevated admission CRP and WBC and decreased platelet count. These factors may be useful in determining risk for critical illness and organ dysfunction in pediatric COVID-19.

Impact of reported level of exposure to COVID-19 patients on physicians in residency and fellowship training programs

Background: During the novel coronavirus-2019 (COVID-19) pandemic, physicians in residency and fellowship training programs are serving as essential healthcare workers while also attempting to continue their preparation for eventual independent practice in their field. We aimed to determine how level of exposure patients with COVID-19 affected the experience of graduate medical trainees in terms of their safety, professional development, and well-being during March and April 2020 Methods: We administered an anonymous, voluntary, web-based survey to physicians enrolled in residency or fellowship training programs in any specialty worldwide A convenience sampling of trainees was obtained through distribution of the survey by email and social media posts from April 20th to May 11th, 2020 To investigate the impact of burden of exposure to COVID-19 the trainee experience, we categorized respondents according to their self-reported estimate of the number of patients with COVID-19 that they provided care for in March and April 2020 (0, 1-30, 31-60, >60). Descriptive statistics were performed and the chi square test was used to evaluate for statistical significance. A multivariable logistic regression analysis was conducted to determine independent predictors of physician burnout Results: Surveys were completed by 1420 trainees, of whom 1031 (73%) were residents Most of the fellows who responded to the survey were training in gastroenterology/ hepatology (27%, 85/280) Trainees who cared for a greater number of COVID-19 patients were more likely to report limited access to PPE and COVID-19 testing and more likely to report testing positive for COVID-19 (Figure 1A) Compared to trainees who did not take care of COVID-19 patients, those who took care of 1-30 patients (adjusted odds ratio [AOR] 1 80, 95% CI 1 29-2 51), 31-60 patients (AOR 3.30, 95% CI 1.86-5.88) and >60 patients (AOR 4.03, 95% CI 2 12-7 63) were increasingly more likely to report burnout More than half (835, 58%) of trainees reported concern about their future preparedness for independent practice Trainees who cared for >60 COVID-19 patients compared to those who did not care for any COVID-19 patients reported similar levels of concern about their preparedness for independent practice (56%, 372/636 vs 58%, 71/125 respectively, p-value 0 57, Figure 1B) Conclusion: Physician trainees who were involved in the care of patients with COVID-19 were more likely to report unsafe working conditions and suffered from higher rates of physician burnout Trainees were concerned about the effects of lost training opportunities on their professional development irrespective of the number of COVID-19 patients they cared for.