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Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study.
BMJ. 2020 08 27; 370:m3249.BMJ

Abstract

OBJECTIVE

To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C).

DESIGN

Prospective observational cohort study with rapid data gathering and near real time analysis.

SETTING

260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020).

PARTICIPANTS

651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2.

MAIN OUTCOME MEASURES

Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C.

RESULTS

Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group.

CONCLUSIONS

Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive).

STUDY REGISTRATION

ISRCTN66726260.

Authors+Show Affiliations

Department of Child Life and Health, University of Edinburgh, Edinburgh, UK. Royal Hospital for Sick Children, Paediatric Infectious Diseases, Edinburgh, UK.Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK. Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK.Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK. Infectious diseases Unit, Royal Liverpool University Hospital, Liverpool, UK.Paediatric Infectious Diseases, Royal Hospital for Children, Glasgow, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, UK.Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, UK.Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK.Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK.Immunisation and Countermeasures Division, Public Health England, Colindale, UK. Paediatric Infectious Disease, St George's Hospital, London, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK. Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK. United Kingdom Department of Health and Social Care, London, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.National Infection Service, Public Health England, [A: Where?]. National Heart and Lung Institute, Imperial College London, London, UK.National Heart and Lung Institute, Imperial College London, London, UK.Roslin Institute, University of Edinburgh, Edinburgh, UK. Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK. Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK.Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK m.g.semple@liverpool.ac.uk. Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32960186

Citation

Swann, Olivia V., et al. "Clinical Characteristics of Children and Young People Admitted to Hospital With Covid-19 in United Kingdom: Prospective Multicentre Observational Cohort Study." BMJ (Clinical Research Ed.), vol. 370, 2020, pp. m3249.
Swann OV, Holden KA, Turtle L, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ. 2020;370:m3249.
Swann, O. V., Holden, K. A., Turtle, L., Pollock, L., Fairfield, C. J., Drake, T. M., Seth, S., Egan, C., Hardwick, H. E., Halpin, S., Girvan, M., Donohue, C., Pritchard, M., Patel, L. B., Ladhani, S., Sigfrid, L., Sinha, I. P., Olliaro, P. L., Nguyen-Van-Tam, J. S., ... Semple, M. G. (2020). Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ (Clinical Research Ed.), 370, m3249. https://doi.org/10.1136/bmj.m3249
Swann OV, et al. Clinical Characteristics of Children and Young People Admitted to Hospital With Covid-19 in United Kingdom: Prospective Multicentre Observational Cohort Study. BMJ. 2020 08 27;370:m3249. PubMed PMID: 32960186.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. AU - Swann,Olivia V, AU - Holden,Karl A, AU - Turtle,Lance, AU - Pollock,Louisa, AU - Fairfield,Cameron J, AU - Drake,Thomas M, AU - Seth,Sohan, AU - Egan,Conor, AU - Hardwick,Hayley E, AU - Halpin,Sophie, AU - Girvan,Michelle, AU - Donohue,Chloe, AU - Pritchard,Mark, AU - Patel,Latifa B, AU - Ladhani,Shamez, AU - Sigfrid,Louise, AU - Sinha,Ian P, AU - Olliaro,Piero L, AU - Nguyen-Van-Tam,Jonathan S, AU - Horby,Peter W, AU - Merson,Laura, AU - Carson,Gail, AU - Dunning,Jake, AU - Openshaw,Peter J M, AU - Baillie,J Kenneth, AU - Harrison,Ewen M, AU - Docherty,Annemarie B, AU - Semple,Malcolm G, AU - ,, Y1 - 2020/08/27/ PY - 2020/08/17/accepted PY - 2020/9/22/entrez PY - 2020/9/23/pubmed PY - 2020/10/2/medline SP - m3249 EP - m3249 JF - BMJ (Clinical research ed.) JO - BMJ VL - 370 N2 - OBJECTIVE: To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). DESIGN: Prospective observational cohort study with rapid data gathering and near real time analysis. SETTING: 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). PARTICIPANTS: 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. MAIN OUTCOME MEASURES: Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. RESULTS: Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. CONCLUSIONS: Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). STUDY REGISTRATION: ISRCTN66726260. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/32960186/Clinical_characteristics_of_children_and_young_people_admitted_to_hospital_with_covid_19_in_United_Kingdom:_prospective_multicentre_observational_cohort_study_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&amp;pmid=32960186 DB - PRIME DP - Unbound Medicine ER -