Outcomes of SARS-CoV-2–Positive Youths Tested in Emergency Departments
Authors: Anna L. Funk, Todd A. Florin, Nathan Kuppermann, Daniel J. Tancredi, Jianling Xie, Kelly Kim, Mark I. Neuman, Lilliam Ambroggio, Amy C. Plint, Santiago Mintegi, Terry P. Klassen, Marina I. Salvadori, Richard Malley, Daniel C. Payne, Norma-Jean Simon, Adriana Yock-Corrales, Jasmine R. Nebhrajani, Pradip P. Chaudhari, Kristen A. Breslin, Yaron Finkelstein, Carmen Campos, Kelly R. Bergmann, Maala Bhatt, Fahd A. Ahmad, Michael A. Gardiner, Usha R. Avva, Nipam P. Shah, Laura F. Sartori, Vikram J. Sabhaney, Kerry Caperell, Nidhya Navanandan, Meredith L. Borland, Claudia R. Morris, Iker Gangoiti, Viviana Pavlicich, Nirupama Kannikeswaran, Maren M. Lunoe, Pedro B. Rino, April J. Kam, Jonathan C. Cherry, Alexander J. Rogers, Shu-Ling Chong, Laura Palumbo, Carlos M. Angelats, Andrea K. Morrison, Maria Y. Kwok, Sarah M. Becker, Andrew C. Dixon, Naveen Poonai, Michelle Eckerle, Muhammad Wassem, Stuart R. Dalziel, Stephen B. Freedman, Jessica Gómez-Vargas, Bethany Lerman, James Chamberlain, Adebola Owolabi, Camilla Schanche-Perret Gentil, Sofie Ringold, Jocy Perez, Heidi Vander Velden, Tyrus Crawford, Steven E Schultz, Kimberly Ross, Kathy Monroe, Karly Stillwell, Jillian Benedetti, Sharon O'Brien, Kyle Pimenta, Amia Andrade, Adam Isacoff, Kendra Sikes, Nina Gold, Kathleen Reichard, Maureen Nemetski, Pavani Avva, Rakesh Mistry, Shanon Young, Marlena Cook, Virginia Gómez Barrena, Sandra Castejón Ramírez, María T García Castellanos, Emma Patterson, Anicka Samuel, Redjana Carciurmaru, Eleanor Fitzpatrick, Megan Bonisch, Bruce Wright, Mithra Sivakumar, Patricia Candelaria, Vincent Cervantes, Shaminy Manoranjithan, Nabeel Khan, Toni Harbour, Usha Sethuraman, Priya Spencer, Neha Gupta, Amira Kamboj, Gael Muanamputu, Guillermo Kohn Loncarica, Eugenia Hernández, Ana Dragovetzky, Isabel Beneyto Ferré, Sylvia Torres, Joseph Zorc, Rebecca Haber, Ren Mee Hiong, Dianna Sri Dewi, Gary Joubert, Kamary Coriolano Dasilva, Julie Ochs, Alberto Arrighini, Camilla Dallavilla, Andrea Kachelmeyer, Daisy Marty Placencia
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. <h3>Objective</h3> To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). <h3>Design, Setting, and Participants</h3> This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. <h3>Exposures</h3> Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. <h3>Main Outcomes and Measures</h3> Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. <h3>Results</h3> Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (&gt;99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to &lt;10 years vs &lt;1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to &lt;18 years vs &lt;1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2–negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2–positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). <h3>Conclusions and Relevance</h3> In this study, approximately 3% of SARS-CoV-2–positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.