Clinical characteristics of children with COVID-19: a systematic review

Tags: Poster
Wang Z1, Zhou Q2, Wang C3, Shi Q2, Lu S4, Xun Y1, Estill J5, Liu E3, Chen Y6
1Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 2The First School of Clinical Medicine, Lanzhou University, 3National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, 4Sichuan Provincial People’s Hospital; School of Medicine, University of Electronic Science and Technology of China, 5Institute of Global Health, University of Geneva; Institute of Mathematical Statistics and Actuarial Science, University of Bern, 6Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation; Chinese GRADE Center; Cochrane China Network, Lanzhou

Background:

Most guidelines on COVID-19 published so far include recommendations for patients regardless of age. Clinicians need a more accurate understanding of the clinical characteristics of children with COVID-19.

Objectives:

To identify the main clinical characteristics of children with COVID-19.

Methods:

We searched studies reporting clinical characteristics in children with COVID-19 published until March 31, 2020 in electronic databases, clinical trial registration platforms, Google Scholar and the preprint servers. We screened the literature, extracted the data and evaluated the risk of bias of the included studies. We combined the dichotomous outcomes like symptoms and CT imaging, using single-arm meta-analysis of rate, and for continuous outcomes, like laboratory results, we combined some of the main outcomes, for the studies with at least nine patients, using single-arm meta-analysis of continuous variables. As clinical and methodological heterogeneity in the study design, characteristics of participants, interventions and outcome measures was expected, we used random-effects models. Heterogeneity was defined as P 50%. We also evaluate the quality of main evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

Results:

Our search retrieved 49 studies, including 25 case reports and 23 case series, with a total of 1667 patients. Our meta-analysis showed that most children with COVID-19 have a mild symptom. 83% of the children were within family clusters of cases, and 19% had no symptoms. The main symptoms of children were fever (48%, 95% confidence interval [CI]: 39%, 56%) and cough (39%, 95%CI: 30%, 48%). Thirty percent [95% CI: 18%, 42%] of children had both cough and fever. At least 7% with digestive symptoms. The lymphocyte count was below normal level in only 15% [95% CI: 4%, 26%] of children which is different from adult patients. 66% [95%CI: 55%, 77%] of children had abnormal findings in CT imaging.

Conclusions:

Children with COVID-19 are more common to have only mild symptoms, and many children are even completely asymptomatic. Fever and cough are the main symptoms of COVID-19 in both children. Vomiting and diarrhea occurring less frequently in children. Ground-glass opacity is the most common CT imaging of children. Whereas adults tend to have elevated lymphocyte count at the beginning of the disease, in children the lymphocytes were usually within the normal range. As the characteristics of COVID-19 differ between adults and children in multiple ways, specific criteria for the diagnosis and treatment of COVID-19 in children are urgently needed.

Patient or healthcare consumer involvement: None