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COVID-19 in 17 Italian Pediatric Emergency Departments #MMPMID32968031
Parri N; Lenge M; Cantoni B; Arrighini A; Romanengo M; Urbino A; Da Dalt L; Verdoni L; Giacchero R; Lanari M; Musolino AM; Biban P; La Fauci G; Pilotto C; Buonsenso D; Chiossi M; Agostiniani R; Plebani A; Zampogna S; Barbieri MA; De Masi S; Agostoni C; Masi S
Pediatrics 2020[Dec]; 146 (6): ä PMID32968031show ga
BACKGROUND: Variability in presentation of children with coronavirus disease 2019 (COVID-19) is a challenge in emergency departments (EDs) in terms of early recognition, which has an effect on disease control and prevention. We describe a cohort of 170 children with COVID-19 and differences with the published cohorts. METHODS: Retrospective chart reviews on children (0-18 years) evaluated in 17 Italian pediatric EDs. RESULTS: In our cohort (median age of 45 months; interquartile range of 4 months-10.7 years), we found a high number of patients <1 year with COVID-19 disease. The exposure happened mainly (59%) outside family clusters; 22% had comorbidities. Children were more frequently asymptomatic (17%) or with mild diseases (63%). Common symptoms were cough (43%) and difficulty feeding (35%). Chest computed tomography, chest radiograph, and point-of-care lung ultrasound were used in 2%, 36%, and 8% of cases, respectively. Forty-three percent of patients were admitted because of their clinical conditions. The minimal use of computed tomography and chest radiograph may have led to a reduced identification of moderate cases, which may have been clinically classified as mild cases. CONCLUSIONS: Italian children evaluated in the ED infrequently have notable disease symptoms. For pediatrics, COVID-19 may have rare but serious and life-threatening presentations but, in the majority of cases, represents an organizational burden for the ED. These data should not lower the attention to and preparedness for COVID-19 disease because children may represent a source of viral transmission. A clinically driven classification, instead of a radiologic, could be more valuable in predicting patient needs and better allocating resources.
Pediatrics 2020 ; 146 (6): ä
