Niccolò Parri1, Matteo Lenge2,3,4, Barbara Cantoni5, Alberto Arrighini6, Marta Romanengo7, Antonio Urbino8, Liviana Da Dalt9, Lucio Verdoni10, Roberta Giacchero11, Marcello Lanari12, Anna Maria Musolino13, Paolo Biban14, Giovanna La Fauci14, Chiara Pilotto15, Danilo Buonsenso16,17, Massimo Chiossi18, Rino Agostiniani19, Anna Plebani20, Stefania Zampogna21, Maria Antonietta Barbieri13, Salvatore De Masi2, Carlo Agostoni22,23, Stefano Masi24. 1. Department of Emergency Medicine and Trauma Center, niccolo.parri@meyer.it. 2. Clinical Trial Office. 3. Child Neurology Unit and Laboratories, Neuroscience Department, and. 4. Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Meyer Children's Hospital, University of Florence, Florence, Italy. 5. Healthcare Professional Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 6. Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy. 7. Istituto di Ricovero e Cura a Carattere Scientifico Istituto Gaslini, Genova, Italy. 8. Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy. 9. Department for Woman and Child Health, Pediatric Emergency Department, University of Padua, Padua, Italy. 10. Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy. 11. Department of Pediatrics, Lodi Hospital, Lodi, Italy. 12. Pediatric Emergency Unit, Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy. 13. Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital and. 14. Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy. 15. Division of Paediatrics, Department of Medicine, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy. 16. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. 17. Università Cattolica del Sacro Cuore, Roma, Italia. 18. Department of Pediatrics, Azienda Sanitaria Locale 4 Liguria, Lavagna, Italy. 19. Department of Pediatrics, Ospedale San Jacopo, Pistoia, Italy. 20. Pediatric Emergency Unit, Filippo Del Ponte Hospital, Azienda Socio Sanitaria Territoriale Settelaghi, Varese, Italy. 21. Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy. 22. University of Milan, Milan, Italy; and. 23. Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 24. Department of Emergency Medicine and Trauma Center.
Abstract
BACKGROUND: Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts. METHODS: Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs. RESULTS: In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases. CONCLUSIONS: Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
BACKGROUND: Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts. METHODS: Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs. RESULTS: In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases. CONCLUSIONS: Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
Authors: Judith J M Wong; Qalab Abbas; Nattachai Anantasit; Naoki Shimizu; Ririe F Malisie; Hongxing Dang; Feng Xu; Jacqueline S M Ong; Pei Chuen Lee; Osamu Saito; Kah Min Pon; Takanari Ikeyama; Muralidharan Jayashree; Rujipat Samransamruajkit; Yibing Cheng; Felix Liauw; Hiroshi Kurosawa; Audrey A N Diaz; Chin Seng Gan; Furong Zhang; Jan Hau Lee Journal: J Pediatr Intensive Care Date: 2021-01-19
Authors: Madeleine W Sumner; Alicia Kanngiesser; Kosar Lotfali-Khani; Nidhi Lodha; Diane Lorenzetti; Anna L Funk; Stephen B Freedman Journal: Front Pediatr Date: 2022-06-09 Impact factor: 3.569