Key Points Question What proportion of SARS-CoV-2–positive youths tested in emergency departments (ED) experience severe outcomes (ie, intensive interventions, severe organ impairment, or death) within 14 days? Findings Among 3221 SARS-CoV-2–positive youths enrolled in a global prospective cohort study with outcome data, 3.3% had severe outcomes within 14 days. Across a subgroup of 2510 SARS-CoV-2–positive youths discharged home after testing, 0.5% had severe outcomes during the 2-week follow-up period. Meaning The findings of this study suggest that risk factors such as age, underlying chronic illness, and symptom duration may be useful for clinicians to consider when evaluating pediatric patients with SARS-CoV-2 infection. This cohort study investigates the prevalence of severe outcomes among youths aged 17 years or younger within 14 days of testing positive for SARS-CoV-2 in emergency departments in 8 countries. Importance Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. Objective To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). Design, Setting, and Participants 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. Exposures Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. Main Outcomes and Measures Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. Results Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>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 <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <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%). Conclusions and Relevance 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.
【초록키워드】 SARS-CoV-2, Hospitalized, Hospitalization, Pneumonia, SARS-COV-2 infection, children, risk, Intervention, Symptom, outcome, Italy, prospective cohort study, risk factor, cohort study, Prevalence, outcomes, nucleic acid, symptom duration, male, Youth, Spain, death, age, Follow-up, Singapore, clinical care, Canada, Intensive, Care, diagnose, Analysis, exposure, Odds ratio, Support, Chronic illness, Factor, Pediatric patient, follow-up period, 95% CI, clinician, measure, participant, finding, impairment, positive, organ, The United States, Complete, youths, objective, country, setting, positive pressure ventilation, polymerase chain, discharged home, initial, Result, enrolled, defined, tested, died, proportion, was performed, characterized, was determined, Importance, New, much lower, IQR, Point, Relevance, SARS-CoV-2–positive, seeking, the median, 【제목키워드】 Youth, Emergency, Department,