Assessment of 135â¯794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States.
JAMA Pediatr
; 175(2): 176-184, 2021 02 01.
Article
in English
| MEDLINE | ID: covidwho-1068645
ABSTRACT
Importance There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and infection among pediatric patients across the United States. Objective:
To describe testing for SARS-CoV-2 and the epidemiology of infected patients. Design, Setting, andParticipants:
A retrospective cohort study was conducted using electronic health record data from 135â¯794 patients younger than 25 years who were tested for SARS-CoV-2 from January 1 through September 8, 2020. Data were from PEDSnet, a network of 7 US pediatric health systems, comprising 6.5 million patients primarily from 11 states. Data analysis was performed from September 8 to 24, 2020. Exposure Testing for SARS-CoV-2. Main Outcomes andMeasures:
SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) illness.Results:
A total of 135â¯794 pediatric patients (53% male; mean [SD] age, 8.8 [6.7] years; 3% Asian patients, 15% Black patients, 11% Hispanic patients, and 59% White patients; 290 per 10â¯000 population [range, 155-395 per 10â¯000 population across health systems]) were tested for SARS-CoV-2, and 5374 (4%) were infected with the virus (12 per 10â¯000 population [range, 7-16 per 10â¯000 population]). Compared with White patients, those of Black, Hispanic, and Asian race/ethnicity had lower rates of testing (Black odds ratio [OR], 0.70 [95% CI, 0.68-0.72]; Hispanic OR, 0.65 [95% CI, 0.63-0.67]; Asian OR, 0.60 [95% CI, 0.57-0.63]); however, they were significantly more likely to have positive test results (Black OR, 2.66 [95% CI, 2.43-2.90]; Hispanic OR, 3.75 [95% CI, 3.39-4.15]; Asian OR, 2.04 [95% CI, 1.69-2.48]). Older age (5-11 years OR, 1.25 [95% CI, 1.13-1.38]; 12-17 years OR, 1.92 [95% CI, 1.73-2.12]; 18-24 years OR, 3.51 [95% CI, 3.11-3.97]), public payer (OR, 1.43 [95% CI, 1.31-1.57]), outpatient testing (OR, 2.13 [1.86-2.44]), and emergency department testing (OR, 3.16 [95% CI, 2.72-3.67]) were also associated with increased risk of infection. In univariate analyses, nonmalignant chronic disease was associated with lower likelihood of testing, and preexisting respiratory conditions were associated with lower risk of positive test results (standardized ratio [SR], 0.78 [95% CI, 0.73-0.84]). However, several other diagnosis groups were associated with a higher risk of positive testresults:
malignant disorders (SR, 1.54 [95% CI, 1.19-1.93]), cardiac disorders (SR, 1.18 [95% CI, 1.05-1.32]), endocrinologic disorders (SR, 1.52 [95% CI, 1.31-1.75]), gastrointestinal disorders (SR, 2.00 [95% CI, 1.04-1.38]), genetic disorders (SR, 1.19 [95% CI, 1.00-1.40]), hematologic disorders (SR, 1.26 [95% CI, 1.06-1.47]), musculoskeletal disorders (SR, 1.18 [95% CI, 1.07-1.30]), mental health disorders (SR, 1.20 [95% CI, 1.10-1.30]), and metabolic disorders (SR, 1.42 [95% CI, 1.24-1.61]). Among the 5374 patients with positive test results, 359 (7%) were hospitalized for respiratory, hypotensive, or COVID-19-specific illness. Of these, 99 (28%) required intensive care unit services, and 33 (9%) required mechanical ventilation. The case fatality rate was 0.2% (8 of 5374). The number of patients with a diagnosis of Kawasaki disease in early 2020 was 40% lower (259 vs 433 and 430) than in 2018 or 2019. Conclusions and Relevance In this large cohort study of US pediatric patients, SARS-CoV-2 infection rates were low, and clinical manifestations were typically mild. Black, Hispanic, and Asian race/ethnicity; adolescence and young adulthood; and nonrespiratory chronic medical conditions were associated with identified infection. Kawasaki disease diagnosis is not an effective proxy for multisystem inflammatory syndrome of childhood.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Ethnicity
/
COVID-19 Testing
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Adolescent
/
Adult
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
/
Young adult
Country/Region as subject:
North America
Language:
English
Journal:
JAMA Pediatr
Year:
2021
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS