Information readily available in electronic health records can identify which children hospitalized with COVID-19 may be candidates for aggressive early treatment.
Demographic characteristics, pre-existing comorbidities and vital signs and laboratory values at the time of admission indicate which children with COVID-19 have a higher risk of serious illness, a recent Research Article shows.
Generally, with COVID-19, children experience milder symptoms than adults. However, COVID-19 can develop into serious illness in children, with outcomes including death and multisystem inflammatory syndrome in children (MIS-C).
The recent research article published by JAMA Network Open, contains data collected from more than 10,000 people under the age of 19 who were hospitalized with COVID-19. The results of the study were first published in Critical care medicine.
That JAMA Network Open research article contains several key data points.
- Data were collected from National COVID Cohort Collaborativewith 1,068,410 children tested for COVID-19 and 167,262 (15.6%) tested positive for the virus
- Among the 10,245 children admitted, 13.9% met the criteria for serious illness (7.8% were placed on mechanical ventilation, 8.5% received vasoactive-inotropic support0.4% was placed on extracorporeal membrane oxygenationand 1.3% died)
- Male (odds ratio 1.37); Black race (odds ratio 1.25); obesity (odds ratio 1.19); and several pediatric complex chronic conditions including cardiovascular, oncological and respiratory conditions were associated with higher serious illness in hospitalized children
- Male gender (odds ratio 1.59), black race (odds ratio 1.44), age below 12 (odds ratio 1.81), obesity (odds ratio 1.76) and not having a pediatric complex condition (odds ratio 0.72) was associated with an increased risk of MIS-C
- Compared with children hospitalized without serious illness, hospitalized children with serious illness had more abnormal values for several vital signs at the beginning of their hospitalization, including systolic and diastolic blood pressure (lower), oxygen saturation measured by pulse oximetry (lower), heart rate (higher) and respiratory rate (higher)
- Compared with children hospitalized without serious illness, hospitalized children with serious illness had more abnormal values for many laboratory test results at the beginning of their hospitalization. In particular, children with severe disease had test results indicating organ dysfunction such as brain type natriuretic peptide (higher), creatinine (higher) and platelets (lower), and inflammation such as ferritin (higher), C-reactive protein (higher) and procalcitonin (higher).
“In this cohort study of American children with SARS-CoV-2, differences in demographic characteristics, pre-existing comorbidities and initial vital signs and laboratory values between severity subgroups were observed. achieved using readily available data elements from the day of admission. ” JAMA Network Open wrote the co-authors of the research article.
Interpretation of data
The results of the research should help in the clinical care of children admitted with COVID-19, the lead author of JAMA Network Open research article told HealthLeaders.
“We hope our study will help clinicians identify children at higher risk of developing serious illness once they are hospitalized with SARS-CoV-2. Specifically, we found that children who were men, “Black / African Americans, overweight, and who have a history of previous chronic medical conditions, specifically previous cardiovascular, oncological, respiratory and technology-dependent conditions, are at higher risk of developing serious illness once admitted,” he said. Blake Martin, MD, attending physician at the Children’s Hospital in Colorado and a member. of the Society of Critical Care Medicine.
It was surprising that not having pre-existing comorbidities was associated with increased odds of a MIS-C diagnosis, he said.
“It would have been reasonable to assume that children who are more medically fragile could be more susceptible to MIS-C, but it ended up being the opposite: that children without significant prior complex medical conditions had an increased risk of receiving a MIS-C diagnosis among children who come to care with a positive SARS-CoV-2 test Much of the discussion about children and SARS-CoV-2 has been that otherwise healthy children perform relatively well and are unlikely to get a “Although this is certainly true in general, I think it’s worth noting that ‘otherwise healthy children’ are still at risk for MIS-C,” Martin said.
Future research should focus on developing clinical decision support tools to help clinicians identify hospitalized children with COVID-19 who may develop into serious illness, he said.
“We now know that there are many pieces of data in the electronic medical record that are associated with an increased chance of serious illness when a child is hospitalized with SARS-CoV-2. The data elements identified in this study (demographics, comorbidity, and hospital vital signs and laboratory values) are all readily available and can be used to design a clinical decision support tool or computer algorithm that automatically identifies high-risk children at the time of their hospitalization.Many research teams are now working on creating these predictive models that we hope will clinicians across the country are able to identify high-risk children who may be candidates for more aggressive, earlier treatment and closer monitoring. “
Christopher Cheney is senior editor of clinical care at HealthLeaders.