COVID-19 Disease in Presenting to the Pediatric Emergency Department: A Multicenter Study of 8886 Cases

• DOI: 10.1016/j.ajem.2022.06.015
• Publication Date: 2022-06-09T19:44:34Z
• Authors: Murat Duman; Nihan Şık; Özlem Tekşam; Halise Akça; Funda Kurt; Ayla Akca Çağlar; Leman Akcan Yıldız; Medine Ayşin Taşar; İlknur Fidancı; Burcu Ceylan Cura...; Durgül Yılmaz; Emre Güngör; Şule Demir; Haluk Çokuğraş; Sinem Oral Cebeci; Pınar Önal; Eylem Ulaş Saz; Ali Yurtseven; Metin Uysalol; Raif Yıldız; Süheyla Gümüş; Alkan Bal; Semra Şen Bayturan; Neslihan Zengin; Sinem Atik; Dilek Yılmaz Çift...; Emel Berksoy; Alper Çiçek; Sabiha Şahin; Mahmut Can Kızıl; Yalçın Kara; Hurşit Apa; Emel Ulusoy; Aybüke Akaslan Kara; Edanur Yesil; Meltem Erdem; Caner Turan; Sertac Arslanoglu; Muhterem Duyu; Gulser Esen Besli; Gazi Arslan; Ayşe Tolunay Oflu; Mehmet Çeleğen; Ebru Buldu; İbrahim Etem Pişkin; Hakan Kardeş; Hayri Levent Yılmaz; Dinçer Yıldızdaş; Gamze Gökulu; Pınar Çay; Utku Özer; Okşan Derinöz Gül...; Özlem Çolak; Songül Tomar Güneysu
• Keywords: Male; Fever; SARS-CoV-2; COVID-19; Article; Systemic Inflammatory Response Syndrome; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Child; Emergency Service, Hospital; Retrospective Studies

The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population.This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded.A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU.Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.