International Analysis of Electronic Health Records of Children and Youth Hospitalized With COVID-19 Infection in 6 Countries
Authors: Florence T. Bourgeois, Alba Gutiérrez-Sacristán, Mark S. Keller, Molei Liu, Chuan Hong, Clara-Lea Bonzel, Amelia L. M. Tan, Bruce J. Aronow, Martin Boeker, John Booth, Jaime Cruz-Rojo, Batsal Devkota, Noelia García-Barrio, Nils Gehlenborg, Alon Geva, David A. Hanauer, Meghan R. Hutch, Richard W. Issitt, Jeffrey G. Klann, Yuan Luo, Kenneth D. Mandl, Chengsheng Mao, Bertrand Moal, Karyn L. Moshal, Shawn N. Murphy, Antoine Neuraz, Kee Yuan Ngiam, Gilbert S Omenn, Lav P. Patel, Miguel Pedrera-Jiménez, Neil J. Sebire, Pablo Serrano-Balazote, Arnaud Serret-Larmande, Andrew M. South, Anastasia Spiridou, Deanne M. Taylor, Patric Tippmann, Shyam Visweswaran, Griffin M. Weber, Isaac S. Kohane, Tianxi Cai, Paul Avillach, James R Aaron, Giuseppe Agapito, Adem Albayrak, Mario Alessiani, Danilo F Amendola, François Angoulvant, Li LLJ Anthony, Andrew Atz, James Balshi, Brett K Beaulieu-Jones, Douglas S Bell, Antonio Bellasi, Riccardo Bellazzi, Vincent Benoit, Michele Beraghi, José Luis Bernal Sobrino, Mélodie Bernaux, Romain Bey, Alvar Blanco Martínez, Silvano Bosari, Robert L Bradford, Gabriel A Brat, Stéphane Bréant, Nicholas W Brown, William A Bryant, Mauro Bucalo, Anita Burgun, Mario Cannataro, Aldo Carmona, Charlotte Caucheteux, Julien Champ, Krista Chen, Jin Chen, Luca Chiovato, Lorenzo Chiudinelli, James J Cimino, Tiago K Colicchio, Sylvie Cormont, Sébastien Cossin, Jean B Craig, Juan Luis Cruz Bermúdez, Arianna Dagliati, Mohamad Daniar, Christel Daniel, Anahita Davoudi, Julien Dubiel, Scott L DuVall, Loic Esteve, Shirley Fan, Robert W Follett, Paula SA Gaiolla, Thomas Ganslandt, Lana X Garmire, Tobias Gradinger, Alexandre Gramfort, Romain Griffier, Nicolas Griffon, Olivier Grisel, Christian Haverkamp, Bing He, Darren W Henderson, Martin Hilka, John H Holmes, Petar Horki, Kenneth M Huling, Anne Sophie Jannot, Vianney Jouhet, Ramakanth Kavuluru, Katie Kirchoff, Ian D Krantz, Detlef Kraska, Ashok K Krishnamurthy, Sehi L'Yi, Trang T Le, Judith Leblanc, Andressa RR Leite, Guillaume Lemaitre, Leslie Lenert, Damien Leprovost, Ne Hooi Will Loh, Kristine E Lynch, Sadiqa Mahmood, Sarah Maidlow, Alberto Malovini, Anupama Maram, Patricia Martel, Aaron J Masino, Michael E Matheny, Thomas Maulhardt, Maria Mazzitelli, Michael T McDuffie, Arthur Mensch, Marianna Milano, Marcos F Minicucci, Jason H Moore, Cinta Moraleda, Jeffrey S Morris, Michele Morris, Sajad Mousavi, Danielle L Mowery, Douglas A Murad, Thomas P Naughton, James B Norman, Jihad Obeid, Marina P Okoshi, Karen L Olson, Gilbert S Omenn, Nina Orlova, Brian D Ostasiewski, Nathan P Palmer, Nicolas Paris, Emily R Pfaff, Danielle Pillion, Hans U Prokosch, Robson A Prudente, Víctor Quirós González, Rachel B Ramoni, Maryna Raskin, Siegbert Rieg, Gustavo Roig Domínguez, Pablo Rojo, Carlos Sáez, Elisa Salamanca, Malarkodi J Samayamuthu, Arnaud Sandrin, Janaina CC Santos, Maria Savino, Emily R Schriver, Juergen Schuettler, Luigia Scudeller, Patricia Serre, Domenick Silvio, Piotr Sliz, Jiyeon Son, Charles Sonday, Bryce WQ Tan, Byorn WL Tan, Suzana E Tanni, Ana I Terriza Torres, Valentina Tibollo, Carlo Torti, Enrico M Trecarichi, Yi-Ju Tseng, Andrew K Vallejos, Gael Varoquaux, Jill-Jênn Vie, Michele Vitacca, Kavishwar B Wagholikar, Lemuel R Waitman, Demian Wassermann, Yuan William, Zongqi Xia, Nadir Yehya, Alberto Zambelli, Harrison G Zhang, Chiara Zucco
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Additional sources of pediatric epidemiological and clinical data are needed to efficiently study COVID-19 in children and youth and inform infection prevention and clinical treatment of pediatric patients. <h3>Objective</h3> To describe international hospitalization trends and key epidemiological and clinical features of children and youth with COVID-19. <h3>Design, Setting, and Participants</h3> This retrospective cohort study included pediatric patients hospitalized between February 2 and October 10, 2020. Patient-level electronic health record (EHR) data were collected across 27 hospitals in France, Germany, Spain, Singapore, the UK, and the US. Patients younger than 21 years who tested positive for COVID-19 and were hospitalized at an institution participating in the Consortium for Clinical Characterization of COVID-19 by EHR were included in the study. <h3>Main Outcomes and Measures</h3> Patient characteristics, clinical features, and medication use. <h3>Results</h3> There were 347 males (52%; 95% CI, 48.5-55.3) and 324 females (48%; 95% CI, 44.4-51.3) in this study's cohort. There was a bimodal age distribution, with the greatest proportion of patients in the 0- to 2-year (199 patients [30%]) and 12- to 17-year (170 patients [25%]) age range. Trends in hospitalizations for 671 children and youth found discrete surges with variable timing across 6 countries. Data from this cohort mirrored national-level pediatric hospitalization trends for most countries with available data, with peaks in hospitalizations during the initial spring surge occurring within 23 days in the national-level and 4CE data. A total of 27 364 laboratory values for 16 laboratory tests were analyzed, with mean values indicating elevations in markers of inflammation (C-reactive protein, 83 mg/L; 95% CI, 53-112 mg/L; ferritin, 417 ng/mL; 95% CI, 228-607 ng/mL; and procalcitonin, 1.45 ng/mL; 95% CI, 0.13-2.77 ng/mL). Abnormalities in coagulation were also evident (D-dimer, 0.78 ug/mL; 95% CI, 0.35-1.21 ug/mL; and fibrinogen, 477 mg/dL; 95% CI, 385-569 mg/dL). Cardiac troponin, when checked (n = 59), was elevated (0.032 ng/mL; 95% CI, 0.000-0.080 ng/mL). Common complications included cardiac arrhythmias (15.0%; 95% CI, 8.1%-21.7%), viral pneumonia (13.3%; 95% CI, 6.5%-20.1%), and respiratory failure (10.5%; 95% CI, 5.8%-15.3%). Few children were treated with COVID-19–directed medications. <h3>Conclusions and Relevance</h3> This study of EHRs of children and youth hospitalized for COVID-19 in 6 countries demonstrated variability in hospitalization trends across countries and identified common complications and laboratory abnormalities in children and youth with COVID-19 infection. Large-scale informatics-based approaches to integrate and analyze data across health care systems complement methods of disease surveillance and advance understanding of epidemiological and clinical features associated with COVID-19 in children and youth.