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PURPOSE: Many articles have been published regarding chest-imaging in COVID-19, but fewer studies have been published in pediatric populations. COVID-19 symptoms in children are generally milder and radiological tests have fewer positive findings. Indications for chest imaging in pediatric COVID-19 patients remain unclear. This study aims to describe the chest radiographs performed in COVID-19 patients in a pediatric hospital, to review the current chest X-ray indications and to develop an specific age-adjusted protocol for chest-imaging in children with COVID-19. METHODS: Retrospective study in hospitalized pediatric COVID-19 patients in Navarre, Spain. Between March and December 2020, 44 children were included (mean age 3.8-year-old, 50 % males). Demographic information, cause of admission, symptoms, and clinical evolution were described. Chest imaging technique performed, indications and findings were analyzed. A literature review was performed searching for current COVID-19 pediatric chest-imaging indications. RESULTS: Chest X-rays were performed in 35 patients (80 % of admissions) and most common indications were fever and respiratory symptoms. 53 % of the chest X-rays were considered "normal" and the classical bilateral diffuse interstitial pattern, described in adults, was only present in 22 %. All patients with pathological chest X-rays were symptomatic and reported fever (100 %) and fever tended to be longer (fever duration: 4.25 vs. 2.46 days p:0.048) in patients with pathological radiographs. We present a specific protocol for chest-imaging in pediatric COVID-19 cases. CONCLUSIONS: COVID-19 clinical manifestations and radiological findings are milder and less specific in children. Imaging should not be used as a screening tool or a routine complementary test in pediatric COVID-19 patients, not even in hospitalized cases.
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BACKGROUND: The pandemic caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has had great effects on health systems worldwide, not only in relation to coronavirus disease 2019 (COVID-19) cases but also affecting patients with other pathologies. METHODS: ECIEN-2020 is an observational study conducted in a tertiary referral hospital in Navarra, Spain. It describes the effects of COVID-19 pandemic and the preventive measures adopted, in pediatric admissions for non-COVID-19 diseases. Admissions during March-June 2020 (first wave of the COVID-19 pandemic in Spain) are described and compared with the same quarter in 2019. A sub-analysis was performed delving into epidemiology. Patient characteristics (age, sex, past medical history), disease characteristics (symptoms, duration of symptoms, previous consultation in Primary Care Health Center), and admission characteristics (place and average stay) were analyzed. RESULTS: A 33% reduction in the number of pediatric hospital admissions was observed, decreasing from 529 hospitalizations in 2019 to 353 in 2020 (P < 0.001). This highlights a 48% reduction in patients admitted for pulmonary diseases. There were no significant changes in average hospital-stay, percentage of intensive care unit admissions, or in admissions for other reasons. Percentage of patients admitted among those seen in the emergency department rose from 5.1% in 2019 to 10.9% in 2020, whereas the total number of consultations in the emergency department decreased by 68%. CONCLUSION: The pandemic and the measures adopted due to SARS-CoV-2 have significantly decreased pediatric admissions for non-COVID-19 diseases, especially due to a reduction in the hospitalization for respiratory diseases.
