Olivia V. Swann
Clinical characteristics of children and young people hospitalised with covid-19 in the United Kingdom: prospective multicentre observational cohort study
Swann, Olivia V.; Holden, Karl A.; Turtle, Lance; Pollock, Louisa; Fairfield, Cameron J.; Drake, Thomas M.; Seth, Sohan; Egan, Conor; Hardwick, Hayley; Halpin, Sophie; Girvan, Michelle; Donohue, Chloe; Pritchard, Mark G; Patel, Latifa; Ladhani, Shamez; Sigfrid, Louise; Sinha, Ian P.; Olliaro, Piero L.; Nguyen-Van-Tam, Jonathan S.; Horby, Peter W.; Merson, Laura; Carson, Gail; Dunning, W. Jake; Openshaw, Peter J.M.; Baillie, J. Kenneth; Harrison, Ewen M.; Docherty, Annemarie B.; Semple, Malcolm Gracie; ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4C) Investigators
Authors
Karl A. Holden
Lance Turtle
Louisa Pollock
Cameron J. Fairfield
Thomas M. Drake
Sohan Seth
Conor Egan
Hayley Hardwick
Sophie Halpin
Michelle Girvan
Chloe Donohue
Mark G Pritchard
Latifa Patel
Shamez Ladhani
Louise Sigfrid
Ian P. Sinha
Piero L. Olliaro
JONATHAN NGUYEN-VAN-TAM Jonathan.Nguyen-Van-tam1@nottingham.ac.uk
Senior Strategy Adviser
Peter W. Horby
Laura Merson
Gail Carson
W. Jake Dunning
Peter J.M. Openshaw
J. Kenneth Baillie
Ewen M. Harrison
Annemarie B. Docherty
Malcolm Gracie Semple
ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4C) Investigators
Abstract
Objective To characterise the clinical features of children and young people admitted to hospital with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to covid-19 (MIS-C). Design Prospective observational cohort study with rapid data gathering and near real time analysis. Setting 260 acute care hospitals in England, Wales, and Scotland between 17th January and 5th June 2020, with a minimal follow-up time of two weeks (to 19th June 2020). Participants 451 children and young people aged less than 19 years admitted to 116 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory-confirmed SARS-CoV-2. Main Outcome Measures Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. Results Median age was 3.9 years [interquartile range (IQR) 0.3-12.9 years], 36% (162/451) were under 12 months old, and 57% (256/450) were male. 56% (224/401) were White, 12% (49/401) South Asian and 10% (40/401) Black. 43% (195/451) had at least one recorded comorbidity. A muco-enteric cluster of symptoms was identified, closely mirroring the WHO MIS-C criteria. 17% of children (72/431) were admitted to critical care. On multivariable analysis this was associated with age under one month odds ratio 5.05 (95% confidence interval 1.69 to 15.72, p=0.004), age 10 to 14 years OR 3.11 (1.21 to 8.55, p=0.022) and Black ethnicity OR 3.02 (1.30 to 6.84, p=0.008). Three young people died (0.7 %, 3/451) aged 16 to 19 years, all of whom had profound comorbidity. Twelve percent of children (36/303) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Those meeting MIS-C criteria were older, (median age 10.8 years ([IQR 8.4-14.1] vs 2.0 [0.2-12.6]), p [less than] 0.001) and more likely to be of non-White ethnicity (70% (23/33) vs 43% (101/237), p=0.005). Children with MIS-C were four times more likely to be admitted to critical care (61% (22/36) vs 15% (40/267, p [less than] 0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with headache (45% (13/29) vs 11% (19/171), p [less than] 0.001), myalgia (39% (11/28) vs 7% (12/170), p [less than] 0.001), sore throat (37% (10/27) vs (13% (24/183, p = 0.004) and fatigue (57% (17/30) vs 31% (60/192), p =0.012) than children who did not and to have a platelet count of less than 150 x109/L (30% (10/33) vs 10% (24/232), p=0.004). Conclusions Our data confirms less severe covid-19 in children and young people than in adults and we provide additional evidence for refining the MIS-C case definition. The identification of a muco-enteric symptom cluster also raises the suggestion that MIS-C is the severe end of a spectrum of disease.
Citation
Swann, O. V., Holden, K. A., Turtle, L., Pollock, L., Fairfield, C. J., Drake, T. M., …ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC4C) Investigators. Clinical characteristics of children and young people hospitalised with covid-19 in the United Kingdom: prospective multicentre observational cohort study
Working Paper Type | Working Paper |
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Deposit Date | Sep 27, 2020 |
Publicly Available Date | Oct 6, 2020 |
Public URL | https://nottingham-repository.worktribe.com/output/4772653 |
Publisher URL | https://www.medrxiv.org/content/10.1101/2020.07.14.20153320v1 |
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