Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. (27th August 2020)

• Record Type: Journal Article
• Authors: Swann, Olivia V; Holden, Karl A; Turtle, Lance; Pollock, Louisa; Fairfield, Cameron J; Drake, Thomas M; Seth, Sohan; Egan, Conor; Hardwick, Hayley E; Halpin, Sophie; Girvan, Michelle; Donohue, Chloe; Pritchard, Mark; Patel, Latifa B; Ladhani, Shamez; Sigfrid, Louise; Sinha, Ian P; Olliaro, Piero L; Nguyen-Van-Tam, Jonathan S; Horby, Peter W; Merson, Laura; Carson, Gail; Dunning, Jake; Openshaw, Peter J M; Baillie, J Kenneth; Harrison, Ewen M; Docherty, Annemarie B; Semple, Malcolm G
• Other Names: author non-byline.; Baillie J Kenneth author non-byline.; Semple Malcolm G author non-byline.; Openshaw Peter J M author non-byline.; Alex Beatrice author non-byline.; Bach Benjamin author non-byline.; Barclay Wendy S author non-byline.; Bogaert Debby author non-byline.; Chand Meera author non-byline.; Cooke Graham S author non-byline.; Docherty Annemarie B author non-byline.; Dunning Jake author non-byline.; da Silva Filipe Ana author non-byline.; Fletcher Tom author non-byline.; Green Christopher A author non-byline.; Harrison Ewen M author non-byline.; Hiscox Julian A author non-byline.; Ying Wai Ho Antonia author non-byline.; Horby Peter W author non-byline.; Ijaz Samreen author non-byline.; Khoo Saye author non-byline.; Klenerman Paul author non-byline.; Law Andrew author non-byline.; Lim Wei Shen author non-byline.; Mentzer Alexander J author non-byline.; Merson Laura author non-byline.; Meynert Alison M author non-byline.; Noursadeghi Mahdad author non-byline.; Moore Shona C author non-byline.; Palmarini Massimo author non-byline.; Paxton William A author non-byline.; Pollakis Georgios author non-byline.; Price Nicholas author non-byline.; Rambaut Andrew author non-byline.; Robertson David L author non-byline.; Russell Clark D author non-byline.; Sancho-Shimizu Vanessa author non-byline.; Scott Janet T author non-byline.; Sigfrid Louise author non-byline.; Solomon Tom author non-byline.; Sriskandan Shiranee author non-byline.; Stuart David author non-byline.; Summers Charlotte author non-byline.; Tedder Richard S author non-byline.; Thomson Emma C author non-byline.; Thwaites Ryan S author non-byline.; Turtle Lance C W author non-byline.; Zambon Maria author non-byline.; Hardwick Hayley author non-byline.; Donohue Chloe author non-byline.; Ewins Jane author non-byline.; Oosthuyzen Wilna author non-byline.; Griffiths Fiona author non-byline.; Norman Lisa author non-byline.; Pius Riinu author non-byline.; Drake Tom M author non-byline.; Fairfield Cameron J author non-byline.; Knight Stephen author non-byline.; Mclean Kenneth A author non-byline.; Murphy Derek author non-byline.; Shaw Catherine A author non-byline.; Dalton Jo author non-byline.; Girvan Michelle author non-byline.; Saviciute Egle author non-byline.; Roberts Stephanie author non-byline.; Harrison Janet author non-byline.; Marsh Laura author non-byline.; Connor Marie author non-byline.; Halpin Sophie author non-byline.; Jackson Clare author non-byline.; Gamble Carrol author non-byline.; Leeming Gary author non-byline.; Law Andrew author non-byline.; Hendry Ross author non-byline.; Greenhalf William author non-byline.; Shaw Victoria author non-byline.; McDonald Sarah author non-byline.; Ahmed Katie A author non-byline.; Armstrong Jane A author non-byline.; Ashworth Milton author non-byline.; Asiimwe Innocent G author non-byline.; Bakshi Siddharth author non-byline.; Barlow Samantha L author non-byline.; Booth Laura author non-byline.; Brennan Benjamin author non-byline.; Bullock Katie author non-byline.; Catterall Benjamin WA author non-byline.; Clark Jordan J author non-byline.; Clarke Emily A author non-byline.; Cole Sarah author non-byline.; Cooper Louise author non-byline.; Cox Helen author non-byline.; Davis Christopher author non-byline.; Dincarslan Oslem author non-byline.; Dunn Chris author non-byline.; Dyer Philip author non-byline.; Elliott Angela author non-byline.; Evans Anthony author non-byline.; Fisher Lewis W S author non-byline.; Foster Terry author non-byline.; Garcia-Dorival Isabel author non-byline.; Greenhalf Willliam author non-byline.; Gunning Philip author non-byline.; Hartley Catherine author non-byline.; Ho Antonia author non-byline.; Jensen Rebecca L author non-byline.; Jones Christopher B author non-byline.; Jones Trevor R author non-byline.; Khandaker Shadia author non-byline.; King Katharine author non-byline.; Kiy Robyn T author non-byline.; Koukorava Chrysa author non-byline.; Lake Annette author non-byline.; Lant Suzannah author non-byline.; Latawiec Diane author non-byline.; Lavelle-Langham L author non-byline.; Lefteri Daniella author non-byline.; Lett Lauren author non-byline.; Livoti Lucia A author non-byline.; Mancini Maria author non-byline.; McDonald Sarah author non-byline.; McEvoy Laurence author non-byline.; McLauchlan John author non-byline.; Metelmann Soeren author non-byline.; Miah Nahida S author non-byline.; Middleton Joanna author non-byline.; Mitchell Joyce author non-byline.; Moore Shona C author non-byline.; Murphy Ellen G author non-byline.; Penrice-Randal Rebekah author non-byline.; Pilgrim Jack author non-byline.; Prince Tessa author non-byline.; Reynolds William author non-byline.; Ridley P. 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• Is Part Of: BMJ. Volume 370(2020)
• Publication Date: 2020-08-27
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.m3249
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). Design: Prospective observational cohort study with rapid data gathering and near real time analysis. Setting: 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). Participants: 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. Main outcome measures: Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. Results: Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 10 9 /L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. Conclusions: Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). Study registration: ISRCTN66726260.