A cross-sectional study of screening for coronavirus disease 2019 (COVID-19) at the pediatric emergency department in Vilnius during the first wave of the pandemic

Abstract

Screening for COVID-19 is based on clinical and epidemiological factors. Children infected with SARS-CoV-2 may have a few or many non-specific symptoms or may be asymptomatic. The aim of this study was to analyze clinical features and exposure to SARS-CoV-2 characteristics of children screened for COVID-19 at the pediatric emergency department in Vilnius during the first 3 months (March-May) of the COVID-19 pandemic in Lithuania. SARS-CoV-2 PCR was positive for 0.6% (8/1348) of all screened children and for 0.9% (7/811) of symptomatic patients, more among children with fever and cough (2.6%, 4/154). There were also COVID-19 cases among children without cough but with other respiratory symptoms (0.5%, 2/409) or gastrointestinal symptoms (1.2%, 3/257). Only one child with positive SARS-CoV-2 did not meet COVID-19 clinical criteria-he presented with vomiting and dehydration only. All COVID-19 cases (n = 8) had a contact with a confirmed COVID-19 family member. There were no COVID-19 cases among children without known exposure to SARS-CoV-2 or among asymptomatic children.Conclusion: Screening for COVID-19 in children is exceptionally challenging due to the diverse and non-specific symptoms of infection they present. Testing strategies should not only focus on the typical COVID-19 symptoms of fever or cough, but also include other symptoms, especially gastrointestinal symptoms, which are also important. The greatest attention should be paid to known exposure to SARS-CoV-2, especially in family clusters. Screening of asymptomatic children with no known exposure should be weighed for medical necessity and cost-effectiveness. What is Known: • Diagnosis of COVID-19 in children is challenging because the disease does not always manifest with typical symptoms. What is New: • Children in our study who did not have symptoms of acute infection and contact with another person infected with COVID-19 were not diagnosed with COVID-19, so the benefit of PCR testing is questionable. Such testing may only be useful for infection control purposes, and to limit intra-hospital transmission.

Keywords: COVID-19; Children; PCR; Pediatric emergency department; Screening.

Fig. 1

Stratification of enrolled children. The single asterisk indicates a history of travelling to affected areas during the last 2 weeks or a close contact with a confirmed or probable COVID-19 case in the last 14 days, while the double asterisks mean a sudden onset of at least one of the following: cough, fever, shortness of breath

Fig. 2

Distribution of A–D groups on a weekly basis. The asterisk indicates COVID-19 positive cases. Group A, cases with known exposure to SARS-CoV-2 and with known COVID-19 symptoms; group B, cases with known exposure to SARS-CoV-2 but without known COVID-19 symptoms; group C, cases without known exposure to SARS-CoV-2 but with known COVID-19 symptoms; group D, cases without known exposure to SARS-CoV-2 and without known COVID-19 symptoms

Fig. 3

Children tested for influenza A and B viruses, March–May 2020