ABSTRACT
BACKGROUND AND AIM: BACKGROUND: Indonesia has experienced two waves of SARS-CoV-2 infection during 2 years of pandemic. The first wave was October 2020 - February 2021 and the second was between May - July 2021. Only few studies comparing the clinical profiles and predictors of severe COVID-19 children between the waves. AIM: To compare the clinical profiles and predictors of severe COVID-19 children between the first and second wave of pandemic. METHOD(S): METHOD: There were 270 children hospitalized with SARSCoV- 2 infection confirmed by RT-PCR during the study period. Twelve children with severe COVID-19 in PICU of 3 hospitals in North Sumatera Indonesia during the first and second waves were enrolled. The data collected were related to clinical characteristics, interventions provided, laboratory findings, and outcomes. RESULT(S): RESULTS: Twelve (4.4%) patients developed severe and critical COVID-19. Eight children in the first wave and the others in the second wave, all of them had comorbidities. Male infants were 50% cases. Fever, cough, dyspnea, and SpO2 < 93% were the most prominent symptoms in first wave cases but neither in the second wave. Low platelet and lymphocyte count with markedly increased C-reactive protein and D-dimer were considered as the predictors of severity. All of the cases were at risk of PARDS with SF ratio below 150. Poor outcome was observed in 87,5% in the first wave versus 25% in the second wave. CONCLUSION(S): CONCLUSION(S): There were major differences comparing the clinical profiles and predictors of severe COVID-19 children between first and second wave of SARS-CoV-2 pandemic.
ABSTRACT
BACKGROUND: Doctors must be able to quickly and accurately assess clinical condition of patients, especially in the emergency rooms. An easy scoring system but producing meaningful clinical conclusions is the reason for creating various scoring systems. It includes a scoring system for predicting the admission status of patients. AIM: The aim of the study was to determine the diagnostic value of pediatric observational priority score (POPS) and early warning scoring system (EWSS) to predicting admission status of pediatric patients in the emergency department. METHODS: Diagnostic tests for POPS and EWSS were done to predict the admission status of pediatric patients in the emergency department of Haji Adam Malik general hospital from May to October 2020. Subjects aged 1 month–18 years were excluded if they left the emergency department before assessment, had trauma cases, died, inpatients due to social indications, and patients who came only to continue therapy were also excluded from the study. POPS and EWSS assessments were carried out by the researcher and the admission status of the patients was determined by the doctor in charge in the emergency department. RESULTS: There were 119 children meeting the inclusion and exclusion criteria. POPS score ≥3 had sensitivity 82.65%, specificity 85.71%, and area under curve (AUC) 0.88 (p < 0.001). EWSS score ≥2 had sensitivity 83.67%, specificity 71.43%, and AUC 0.83 (p < 0.001). CONCLUSION: POPS and EWSS had good diagnostic values in predicting the admission status of pediatric patients in the emergency department. POPS has a slightly higher diagnostic value than EWSS.