International study identifies predictors of severe outcomes in children with COVID-19

A new international study offers a clearer picture of the impact of COVID-19 infection and the risk of severe outcomes on young people around the world.   

The study was co-led by a team of researchers from UC Davis Health, University of Calgary’s Cumming School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago. It followed more than 10,300 children at 41 emergency departments in 10 countries, including the United States and Canada. 

Researchers tracked more than 3,200 of those children who tested positive for COVID-19. Approximately three percent (107 total) of those diagnosed with COVID-19 experienced severe outcomes within two weeks of their visit to an emergency department. In addition, 23 percent (735 total), were hospitalized for treatment. Severe outcomes included cardiac or cardiovascular complications, such as myocarditis (inflammation of the heart), as well as neurologic, respiratory, or infectious problems. Four children died. 

The study identified patients older than five years of age, having a pre-existing chronic illness, a previous episode of pneumonia, and presenting to the hospital four to seven days after symptom onset were at higher risk for severe outcomes. 

“The results of our study show that risk factors such as age, underlying chronic illness, and symptom duration were important risk factors for severe outcomes," said Nathan Kuppermann, chair of the Department of Emergency Medicine and co-lead of the study. "

With emergency departments across the world seeing an influx of patients due to the COVID-19 pandemic and stressing capacity, this study will help address the surge by providing an estimate of the risk among pediatric COVID-19 patients screened in emergency departments.” —Nathan Kuppermann

Researchers found children not admitted to the hospital at an initial emergency department visit rarely deteriorated significantly after the first visit. 

“Fortunately, the risk of developing severe disease in children with COVID-19 discharged from the emergency department is very low,” said study co-lead Todd Florin, director of research in emergency medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and associate professor of pediatrics at Northwestern University Feinberg School of Medicine. “Our findings can provide reassurance to parents and clinicians for children well enough to be managed in the community, while also providing important insights on which children may be at particular risk for severe outcomes." 

Although asthma has previously been suggested as a risk factor for severe outcome, this study was not able to confirm a link. It also did not find that very young infants were at a higher risk for severe outcomes. 

“With emergency departments across the world seeing an influx of patients due to the COVID-19 pandemic and stressing capacity, this study will help address the surge by providing an estimate of the risk among pediatric COVID-19 patients screened in emergency departments,” said Kuppermann. “It will help emergency physicians triage pediatric patients more efficiently by knowing who has risk factors for severe outcomes and focus advanced level care to those who do.” 

The study occurred within the Pediatric Emergency Research Network, a global consortium of the world's major pediatric emergency care research networks. It received support from the Canadian Institutes of Health Research, Alberta Innovates, Alberta Health Services and the University of Calgary. It also received COVID grant funding from the University of California Davis, Cincinnati Children’s Hospital Medical Center and Ann and Robert H. Lurie Children’s Hospital of Chicago. 

“There are no specific evidence-based treatments and therapies for children at this time and detailed research data describing outcomes in young people with COVID-19 has been lacking, so this study offers important insights that we believe will be helpful into front-line care providers treating children with COVID-19,” added study co-lead Stephen Freedman, pediatrician and professor at University of Calgary’s Cumming School of Medicine.