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. 2022 Nov 30;20(1):465.
doi: 10.1186/s12916-022-02664-y.

Predictive model for long COVID in children 3 months after a SARS-CoV-2 PCR test

Manjula D Nugawela  1 , Terence Stephenson  1 , Roz Shafran  1 , Bianca L De Stavola  1 , Shamez N Ladhani  2   3 , Ruth Simmons  3 , Kelsey McOwat  3 , Natalia Rojas  1 , Emma Dalrymple  1 , Emily Y Cheung  1 , Tamsin Ford  4 , Isobel Heyman  1 , Esther Crawley  5 , Snehal M Pinto Pereira  6
Affiliations

Predictive model for long COVID in children 3 months after a SARS-CoV-2 PCR test

Manjula D Nugawela et al. BMC Med. .

Abstract

Background: To update and internally validate a model to predict children and young people (CYP) most likely to experience long COVID (i.e. at least one impairing symptom) 3 months after SARS-CoV-2 PCR testing and to determine whether the impact of predictors differed by SARS-CoV-2 status.

Methods: Data from a nationally matched cohort of SARS-CoV-2 test-positive and test-negative CYP aged 11-17 years was used. The main outcome measure, long COVID, was defined as one or more impairing symptoms 3 months after PCR testing. Potential pre-specified predictors included SARS-CoV-2 status, sex, age, ethnicity, deprivation, quality of life/functioning (five EQ-5D-Y items), physical and mental health and loneliness (prior to testing) and number of symptoms at testing. The model was developed using logistic regression; performance was assessed using calibration and discrimination measures; internal validation was performed via bootstrapping and the final model was adjusted for overfitting.

Results: A total of 7139 (3246 test-positives, 3893 test-negatives) completing a questionnaire 3 months post-test were included. 25.2% (817/3246) of SARS-CoV-2 PCR-positives and 18.5% (719/3893) of SARS-CoV-2 PCR-negatives had one or more impairing symptoms 3 months post-test. The final model contained SARS-CoV-2 status, number of symptoms at testing, sex, age, ethnicity, physical and mental health, loneliness and four EQ-5D-Y items before testing. Internal validation showed minimal overfitting with excellent calibration and discrimination measures (optimism-adjusted calibration slope: 0.96575; C-statistic: 0.83130).

Conclusions: We updated a risk prediction equation to identify those most at risk of long COVID 3 months after a SARS-CoV-2 PCR test which could serve as a useful triage and management tool for CYP during the ongoing pandemic. External validation is required before large-scale implementation.

Keywords: COVID-19; Children and young people; Long COVID; Predictive model; Public health; Symptoms.

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Conflict of interest statement

Sir Professor Stephenson is the Chair of the Health Research Authority and therefore recused himself from the research ethics application. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Observed and predicted risk of long COVID 3 months after a PCR test. This graph shows the mean predicted probability (hollow dots) and 95% confidence intervals of long COVID 3 months after a PCR test plotted against the observed proportion of the same outcome for 10 equally sized groups. The dashed line represents the line of equality and perfect calibration. The blue solid line is a smoothed locally weighted scatter plot smoothing (Lowess) regression line
See this image and copyright information in PMC

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