Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Jan 4;5(1):e2142322.
doi: 10.1001/jamanetworkopen.2021.42322.

Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study

Anna L Funk  1 , Todd A Florin  2   3 , Nathan Kuppermann  4 , Daniel J Tancredi  5 , Jianling Xie  1 , Kelly Kim  1 , Mark I Neuman  6   7 , Lilliam Ambroggio  8 , Amy C Plint  9 , Santiago Mintegi  10 , Terry P Klassen  11 , Marina I Salvadori  12 , Richard Malley  13 , Daniel C Payne  14 , Norma-Jean Simon  15 , Adriana Yock-Corrales  16 , Jasmine R Nebhrajani  17 , Pradip P Chaudhari  18   19 , Kristen A Breslin  20 , Yaron Finkelstein  21 , Carmen Campos  22 , Kelly R Bergmann  23 , Maala Bhatt  24 , Fahd A Ahmad  25 , Michael A Gardiner  26 , Usha R Avva  27 , Nipam P Shah  28 , Laura F Sartori  29 , Vikram J Sabhaney  30 , Kerry Caperell  31 , Nidhya Navanandan  8 , Meredith L Borland  32 , Claudia R Morris  33 , Iker Gangoiti  10 , Viviana Pavlicich  34 , Nirupama Kannikeswaran  35 , Maren M Lunoe  36 , Pedro B Rino  37 , April J Kam  38 , Jonathan C Cherry  39 , Alexander J Rogers  40 , Shu-Ling Chong  41 , Laura Palumbo  42 , Carlos M Angelats  43 , Andrea K Morrison  44 , Maria Y Kwok  45 , Sarah M Becker  46 , Andrew C Dixon  47 , Naveen Poonai  48 , Michelle Eckerle  49   50 , Muhammad Wassem  51 , Stuart R Dalziel  52   53 , Stephen B Freedman  54 ; Pediatric Emergency Research Network-COVID-19 Study Team
Collaborators, Affiliations
Multicenter Study

Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study

Anna L Funk et al. JAMA Netw Open. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Florin reported receiving grants from the National Institute of Allergy and Infectious Diseases and the National Heart, Lung, and Blood Institute outside the submitted work. Dr Ambroggio reported receiving grants from Pfizer outside the submitted work. Dr Malley reported receiving personal fees from Merck as a consultant, grants from Pfizer, grants from Astellas, and reported being a board member and consultant for Affinivax Scientific Founder outside the submitted work. Dr Morris reported royalties from intellectual property from UCSF Benioff Children's Hospital Oakland; grants from NIH/NHLBI, grants from FDA, and grants from NIH/NCCIM outside the submitted work; in addition, Dr Morris had a patent for therapeutics related to Arginine bioavailability in COVID-19 and MISC pending. Dr Becker reported receiving Primary Children's Hospital Fee per enrolled study participant from University of Utah during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow of SARS-CoV-2–Positive Study Participants Including Outcomes and Follow-up
ED indicates emergency department; ICU, intensive care unit. aFive of 3221 youths did not test positive on day 0, but did within 14 days. bIncludes 8 youths transferred to other tertiary facilities. cAs per analysis plan, considers only youths with full 14-day follow-up.
Figure 2.
Figure 2.. Severe Outcomes Among SARS-CoV-2–Positive Study Participants Displayed in Relation to Month of Enrollment
See this image and copyright information in PMC

References

    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648 - DOI - PubMed
    1. Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA. 2020;323(14):1335. doi:10.1001/jama.2020.4344 - DOI - PubMed
    1. CDC COVID-19 Response Team . Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422-426. doi:10.15585/mmwr.mm6914e4 - DOI - PMC - PubMed
    1. Paquette D, Bell C, Roy M, et al. . Laboratory-confirmed COVID-19 in children and youth in Canada, January 15-April 27, 2020. Can Commun Dis Rep. 2020;46(5):121-124. doi:10.14745/ccdr.v46i05a04 - DOI - PMC - PubMed
    1. Davies NG, Klepac P, Liu Y, Prem K, Jit M, Eggo RM; CMMID COVID-19 working group . Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med. 2020;26(8):1205-1211. doi:10.1038/s41591-020-0962-9 - DOI - PubMed

Publication types