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Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States.
JAMA Pediatr. 2021 02 01; 175(2):176-184.JP

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, and Participants

A retrospective cohort study was conducted using electronic health record data from 135 794 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 and Measures

SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) illness.

Results

A total of 135 794 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 10 000 population [range, 155-395 per 10 000 population across health systems]) were tested for SARS-CoV-2, and 5374 (4%) were infected with the virus (12 per 10 000 population [range, 7-16 per 10 000 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 test results: 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.

Authors+Show Affiliations

Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Biomedical Research Informatics Center, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, Delaware.Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Seattle Children's Research Institute, University of Washington, Department of Pediatrics, Seattle. Editor, JAMA Pediatrics.Biomedical Research Informatics Center, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, Delaware.Research IT R&D, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.Department of Research Information Solutions and Innovation, Nationwide Children's Hospital, Columbus, Ohio.Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, Missouri.Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri.Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.Seattle Children's Research Institute, University of Washington, Department of Pediatrics, Seattle.Department of Pediatrics (Infectious Diseases, Hospital Medicine and Epidemiology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora.Research Informatics-Analytics Resource Center, Children's Hospital Colorado, Aurora.Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Pub Type(s)

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

Language

eng

PubMed ID

33226415

Citation

Bailey, L Charles, et al. "Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States." JAMA Pediatrics, vol. 175, no. 2, 2021, pp. 176-184.
Bailey LC, Razzaghi H, Burrows EK, et al. Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States. JAMA Pediatr. 2021;175(2):176-184.
Bailey, L. C., Razzaghi, H., Burrows, E. K., Bunnell, H. T., Camacho, P. E. F., Christakis, D. A., Eckrich, D., Kitzmiller, M., Lin, S. M., Magnusen, B. C., Newland, J., Pajor, N. M., Ranade, D., Rao, S., Sofela, O., Zahner, J., Bruno, C., & Forrest, C. B. (2021). Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States. JAMA Pediatrics, 175(2), 176-184. https://doi.org/10.1001/jamapediatrics.2020.5052
Bailey LC, et al. Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States. JAMA Pediatr. 2021 02 1;175(2):176-184. PubMed PMID: 33226415.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States. AU - Bailey,L Charles, AU - Razzaghi,Hanieh, AU - Burrows,Evanette K, AU - Bunnell,H Timothy, AU - Camacho,Peter E F, AU - Christakis,Dimitri A, AU - Eckrich,Daniel, AU - Kitzmiller,Melody, AU - Lin,Simon M, AU - Magnusen,Brianna C, AU - Newland,Jason, AU - Pajor,Nathan M, AU - Ranade,Daksha, AU - Rao,Suchitra, AU - Sofela,Olamiji, AU - Zahner,Janet, AU - Bruno,Cortney, AU - Forrest,Christopher B, PY - 2020/11/24/pubmed PY - 2021/2/12/medline PY - 2020/11/23/entrez SP - 176 EP - 184 JF - JAMA pediatrics JO - JAMA Pediatr VL - 175 IS - 2 N2 - 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, and Participants: A retrospective cohort study was conducted using electronic health record data from 135 794 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 and Measures: SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) illness. Results: A total of 135 794 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 10 000 population [range, 155-395 per 10 000 population across health systems]) were tested for SARS-CoV-2, and 5374 (4%) were infected with the virus (12 per 10 000 population [range, 7-16 per 10 000 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 test results: 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. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/33226415/Assessment_of_135_794_Pediatric_Patients_Tested_for_Severe_Acute_Respiratory_Syndrome_Coronavirus_2_Across_the_United_States_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2020.5052 DB - PRIME DP - Unbound Medicine ER -