PD162 - MANIFESTATIONS AND CLINICAL PHENOTYPES ARE NOT SPECIFIC ENOUGH TO PREDICT SARS-COV-2 INFECTION IN SYMPTOMATIC CHILDREN (ID 1024)
- David Aguilera-Alonso (Spain)
- Elena Cobos-Carrascosa (Spain)
- Álvaro Ballesteros (Spain)
- Juan Miguel Mesa (Spain)
- Paula García (Spain)
- Ignacio Navarro (Spain)
- José Antonio Alonso-Cadenas (Spain)
- Amanda Bermejo (Spain)
- Gema Sabrido (Spain)
- Leticia Martinez-Campos (Spain)
- Aranzazu Flavia González-Posada (Spain)
- Marta Illán-Ramos (Spain)
- Jorge Lorente (Spain)
- Ana Belen Jimenez (Spain)
- Rut Del Valle (Spain)
- Sara Domínguez (Spain)
- Alfredo Tagarro (Spain)
- Cinta Moraleda (Spain)
Abstract
Backgrounds:
A symptom-based screening for SARS-CoV-2 diagnosis could be useful. This study aimed to analyze symptoms/signs associated with SARS-CoV-2 laboratory-confirmed infection among symptomatic children screened for COVID-19 and to define clinical phenotypes that could differentiate COVID-19 from other infections.
Methods
Cross-sectional multicenter study, nested in a prospective, observational cohort, EPICO-AEP, including children <18 years old with symptoms compatible with SARS-CoV-2 infection of ≤5 days of duration attended at the emergency departments of ten hospitals in Spain, from 2/5/2021 to 15/6/2021. SARS-CoV-2 infection was diagnosed by reverse transcription-polymerase chain reaction (RT-PCR) in nasopharyngeal swab samples. Patients were classified into two age groups (≤3 and >3 years). Two-stage factor analysis was used to define clinical phenotypes.
Results:
1,174 children were attended with symptoms compatible with COVID-19; median age 3.8 years (IQR: 1.7-9.0), 518 (44.5%) females. 68 (5.8%) had a positive SARS-CoV-2 RT-PCR: 16/516 (3.1%) if ≤3 years and 52/657 (7.9%) if >3 years. Children with COVID-19, compared to negative cases, had significantly less vomiting/nausea (p=0.005) and diarrhea (p=0.001), but more headache (p<0.001), myalgia (p<0.001) and arthralgia (p=0.037). The selected clinical phenotypes were: Lower Respiratory (dyspnea, wheezing, and chest indrawing), Upper Respiratory, (runny nose and cough), Gastrointestinal (abdominal pain, vomiting/nausea, and diarrhea), and Flu-like (arthralgia, myalgia, fatigue, headache, and sore throat). In younger children, no clinical phenotype was associated with higher odds of positive SARS-CoV-2, but in older children, Flu-like phenotype was associated with positive SARS-CoV-2 (OR: 1.84 [CI 95%: 1.09-3.11], p=0.023) and Gastrointestinal phenotype with negative SARS-CoV-2 (OR: 0.56 [CI 95%: 0.34-0.91], p=0.020)(Table 1).
Conclusions/Learning Points:
Although some symptoms (headache, myalgia, and arthralgia), or phenotypes (Influenza-like in older children) were more common among children with SARS-CoV-2 infection, they are not specific enough to diagnose SARS-CoV-2 infection.
