News: EHR data can identify aggressive early treatment candidates for children hospitalized with COVID-19

Demographics, preexisting comorbidities, vital signs, and laboratory values at the time of hospitalization can indicate which children with COVID-19 are at higher risk of severe illness, and which are good candidates for aggressive early treatment, according to a study published in the Journal of the American Medical Association Network Open.

HealthLeaders reported that the research article includes several key data points:

• Data was collected from the National COVID Cohort Collaborative, with 1,068,410 children tested for COVID-19 and 167,262 (15.6%) testing positive for the virus. Among the 10,245 children who were hospitalized, 13.9% met criteria for severe illness (7.8% were placed on mechanical ventilation, 8.5% received vasoactive-inotropic support, 0.4% were placed on extracorporeal membrane oxygenation, and 1.3% died). Compared with children who were hospitalized without severe illness, hospitalized children with severe illness had more abnormal values for several vital signs at the beginning of their hospitalization, including systolic and diastolic blood pressure (lower), oxygen saturation as measured by pulse oximetry (lower), heart rate (higher), and respiratory rate (higher)

Hospitalized children with severe illness also had more abnormal values for many laboratory test results at the beginning of their hospitalization. In particular, children with severe illness had test results that indicated organ dysfunction such as brain-type natriuretic peptide (higher), creatinine (higher), and platelets (lower), and inflammation such as ferritin (higher), C-reactive protein (higher), and procalcitonin (higher).

Additionally:

• Male sex (odds ratio 1.37); Black race (odds ratio 1.25); obesity (odds ratio 1.19); and several pediatric complex chronic conditions including cardiovascular, oncologic, and respiratory conditions were associated with higher severity illness in hospitalized children
• Male sex (odds ratio 1.59), Black race (odds ratio 1.44), age under 12 (odds ratio 1.81), obesity (odds ratio 1.76), and not having a pediatric complex condition (odds ratio 0.72) were associated with increased risk for MIS-C

Authors of the study say that the findings should help in the clinical care of children hospitalized with COVID-19.

"We hope that our study will assist clinicians in identifying children at higher risk of developing severe disease once hospitalized with SARS-CoV-2," said Blake Martin, MD, pediatric critical care attending physician at Children's Hospital Colorado and a member of the Society of Critical Care Medicine.

Future research should focus on developing clinical decision support tools to help clinicians identify hospitalized children with COVID-19 who could progress to severe illness, Martin added.

Editor’s note: This article was originally published by HealthLeaders.