There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and infection among pediatric patients across the United States.
To describe testing for ...SARS-CoV-2 and the epidemiology of infected patients.
A retrospective cohort study was conducted using electronic health record data from 135 794 patients younger than 25 years who were tested for SARS-CoV-2 from January 1 through September 8, 2020. Data were from PEDSnet, a network of 7 US pediatric health systems, comprising 6.5 million patients primarily from 11 states. Data analysis was performed from September 8 to 24, 2020.
Testing for SARS-CoV-2.
SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) illness.
A total of 135 794 pediatric patients (53% male; mean SD age, 8.8 6.7 years; 3% Asian patients, 15% Black patients, 11% Hispanic patients, and 59% White patients; 290 per 10 000 population range, 155-395 per 10 000 population across health systems) were tested for SARS-CoV-2, and 5374 (4%) were infected with the virus (12 per 10 000 population range, 7-16 per 10 000 population). Compared with White patients, those of Black, Hispanic, and Asian race/ethnicity had lower rates of testing (Black: odds ratio OR, 0.70 95% CI, 0.68-0.72; Hispanic: OR, 0.65 95% CI, 0.63-0.67; Asian: OR, 0.60 95% CI, 0.57-0.63); however, they were significantly more likely to have positive test results (Black: OR, 2.66 95% CI, 2.43-2.90; Hispanic: OR, 3.75 95% CI, 3.39-4.15; Asian: OR, 2.04 95% CI, 1.69-2.48). Older age (5-11 years: OR, 1.25 95% CI, 1.13-1.38; 12-17 years: OR, 1.92 95% CI, 1.73-2.12; 18-24 years: OR, 3.51 95% CI, 3.11-3.97), public payer (OR, 1.43 95% CI, 1.31-1.57), outpatient testing (OR, 2.13 1.86-2.44), and emergency department testing (OR, 3.16 95% CI, 2.72-3.67) were also associated with increased risk of infection. In univariate analyses, nonmalignant chronic disease was associated with lower likelihood of testing, and preexisting respiratory conditions were associated with lower risk of positive test results (standardized ratio SR, 0.78 95% CI, 0.73-0.84). However, several other diagnosis groups were associated with a higher risk of positive test results: malignant disorders (SR, 1.54 95% CI, 1.19-1.93), cardiac disorders (SR, 1.18 95% CI, 1.05-1.32), endocrinologic disorders (SR, 1.52 95% CI, 1.31-1.75), gastrointestinal disorders (SR, 2.00 95% CI, 1.04-1.38), genetic disorders (SR, 1.19 95% CI, 1.00-1.40), hematologic disorders (SR, 1.26 95% CI, 1.06-1.47), musculoskeletal disorders (SR, 1.18 95% CI, 1.07-1.30), mental health disorders (SR, 1.20 95% CI, 1.10-1.30), and metabolic disorders (SR, 1.42 95% CI, 1.24-1.61). Among the 5374 patients with positive test results, 359 (7%) were hospitalized for respiratory, hypotensive, or COVID-19-specific illness. Of these, 99 (28%) required intensive care unit services, and 33 (9%) required mechanical ventilation. The case fatality rate was 0.2% (8 of 5374). The number of patients with a diagnosis of Kawasaki disease in early 2020 was 40% lower (259 vs 433 and 430) than in 2018 or 2019.
In this large cohort study of US pediatric patients, SARS-CoV-2 infection rates were low, and clinical manifestations were typically mild. Black, Hispanic, and Asian race/ethnicity; adolescence and young adulthood; and nonrespiratory chronic medical conditions were associated with identified infection. Kawasaki disease diagnosis is not an effective proxy for multisystem inflammatory syndrome of childhood.
Background:
High-intensity functional training (HIFT) is a new training modality that merges high-intensity exercise with functional (multijoint) movements. Even though others exist, CrossFit ...training has emerged as the most common form of HIFT. Recently, several reports have linked CrossFit training to severe injuries and/or life-threatening conditions, such as rhabdomyolysis. Empirical evidence regarding the safety of this training modality is currently limited.
Purpose:
To examine the incidence of injuries related to CrossFit participation and to estimate the rate of injuries in a large cross-sectional convenience sample of CrossFit participants from around the world.
Study Design:
Descriptive epidemiology study.
Methods:
A total of 3049 participants who reported engaging in CrossFit training between 2013 and 2017 were surveyed.
Results:
A portion (30.5%) of the participants surveyed reported experiencing an injury over the previous 12 months because of their participation in CrossFit training. Injuries to the shoulders (39%), back (36%), knees (15%), elbows (12%), and wrists (11%) were most common for both male and female participants. The greatest number of injuries occurred among those who participated in CrossFit training 3 to 5 days per week (χ2 = 12.51; P = .0019). Overall, and based on the assumed maximum number of workout hours per week, the injury rate was 0.27 per 1000 hours (females: 0.28; males: 0.26), whereas the assumed minimum number of workout hours per week resulted in an injury rate of 0.74 per 1000 hours (females: 0.78; males: 0.70).
Conclusion:
Our findings suggest that CrossFit training is relatively safe compared with more traditional training modalities. However, it seems that those within their first year of training as well as those who engage in this training modality less than 3 days per week and/or participate in less than 3 workouts per week are at a greater risk for injuries.
Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking.
This retrospective cohort study ...utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours.
We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio IRR, 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5).
Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.
Background
IgA vasculitis is the most common vasculitis in children and is often complicated by acute nephritis (IgAVN). Risk of chronic kidney disease (CKD) among children with IgAVN remains ...unknown. This study aimed to describe the clinical management and kidney outcomes in a large cohort of children with IgAVN.
Methods
This observational cohort study used the PEDSnet database to identify children diagnosed with IgAV between January 1, 2009, and February 29, 2020. Demographic and clinical characteristics were compared among children with and without kidney involvement. For children followed by nephrology, clinical course, and management patterns were described. Patients were divided into four categories based on treatment: observation, renin–angiotensin–aldosterone system (RAAS) blockade, corticosteroids, and other immunosuppression, and outcomes were compared among these groups.
Results
A total of 6802 children had a diagnosis of IgAV, of whom 1139 (16.7%) were followed by nephrology for at least 2 visits over a median follow-up period of 1.7 years 0.4,4.2. Conservative management was the most predominant practice pattern, consisting of observation in 57% and RAAS blockade in 6%. Steroid monotherapy was used in 29% and other immunosuppression regimens in 8%. Children receiving immunosuppression had higher rates of proteinuria and hypertension compared to those managed with observation (
p
< 0.001). At the end of follow-up, 2.6 and 0.5% developed CKD and kidney failure, respectively.
Conclusions
Kidney outcomes over a limited follow-up period were favorable in a large cohort of children with IgAV. Immunosuppressive medications were used in those with more severe presentations and may have contributed to improved outcomes.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information
Purpose To examine the clinical, demographic, and anthropometric patient characteristics of secondary pseudotumor cerebri syndrome in children and adolescents based on the recently revised diagnostic ...criteria. Design Retrospective observational case series. Methods Patients seen at a tertiary children’s hospital for pseudotumor cerebri syndrome were classified as having either primary idiopathic (n = 59) or secondary pseudotumor cerebri syndrome (n = 16), as rigorously defined by recently revised diagnostic criteria. Outcomes included body mass index Z-scores (BMI-Z), height and weight Z-scores, demographics, and clinical features at presentation, such as headache, sixth nerve palsy, and cerebrospinal fluid (CSF) opening pressure. Results In this cohort, the associated conditions and exposures seen in definite secondary pseudotumor cerebri syndrome included tetracycline-class antibiotics (n = 11), chronic kidney disease (n = 3), withdrawal from chronic glucocorticoids (n = 1), and lithium (n = 1). Other associations observed in the possible secondary pseudotumor cerebri syndrome group included Down syndrome, vitamin A derivatives, and growth hormone. In comparison with primary pseudotumor cerebri syndrome, definite secondary pseudotumor cerebri syndrome patients were on average older (15.0 vs 11.6 years; P = .003, Mann-Whitney test). According to US Centers for Disease Control (CDC) classifications, 79% of children with secondary pseudotumor cerebri syndrome were either overweight or obese (36% overweight n = 5 and 43% obese n = 6), as compared to 32% nationally. Conclusions Even when a potential inciting exposure is identified for pediatric pseudotumor cerebri syndrome, the possible contribution of overweight and obesity should be considered.
Background
Sharing data across institutions is critical to improving care for children who are using long‐term mechanical ventilation (LTMV). Mechanical ventilation data are complex and poorly ...standardized. This lack of data standardization is a major barrier to data sharing.
Objective
We aimed to describe current ventilator data in the electronic health record (EHR) and propose a framework for standardizing these data using a common data model (CDM) across multiple populations and sites.
Methods
We focused on a cohort of patients with LTMV dependence who were weaned from mechanical ventilation (MV). We extracted and described relevant EHR ventilation data. We identified the minimum necessary components, termed “Clinical Ideas,” to describe MV from time of initiation to liberation. We then utilized existing resources and partnered with informatics collaborators to develop a framework for incorporating Clinical Ideas into the PEDSnet CDM based on the Observational Medical Outcomes Partnership (OMOP).
Results
We identified 78 children with LTMV dependence who weaned from ventilator support. There were 25 unique device names and 28 unique ventilation mode names used in the cohort. We identified multiple Clinical Ideas necessary to describe ventilator support over time: device, interface, ventilation mode, settings, measurements, and duration of ventilation usage per day. We used Concepts from the SNOMED‐CT vocabulary and integrated an existing ventilator mode taxonomy to create a framework for CDM and OMOP integration.
Conclusion
The proposed framework standardizes mechanical ventilation terminology and may facilitate efficient data exchange in a multisite network. Rapid data sharing is necessary to improve research and clinical care for children with LTMV dependence.
Purpose
22q11.2 deletion syndrome (22q11.2DS) can present with a variety challenges to patients and their caregivers, many of which require surgical evaluation and intervention. Surgical needs can ...also extend long into adulthood, prompting evaluation and intervention throughout development and beyond. Here, we identify common concerns and patient needs associated with the 22q11.2DS from a general surgery perspective, their management, and typical management based on our institution’s experience with 1263 patients.
Methods
1263 patients evaluated and treated at the 22q And You Center at the Children’s Hospital of Philadelphia were enrolled and included in the study, from January 1992 to May 2017 Co-morbidities, procedures, and imaging studies performed were quantified and assessed via descriptive analysis.
Results
Gastroesophageal reflux disease (GERD) and feeding difficulties were the most common surgical issues identified, while gastrostomy tube placement, anorectal procedures, and hernia repairs were the most common surgical interventions performed by general surgeons.
Conclusions
General surgical procedures are commonly needed in this population and are part of the complex needs these patients and their surgeons may encounter in the setting of a 22q11.2DS diagnosis. These findings will help to inform a well-coordinated, multidisciplinary approach to care.
Summary
Despite the importance of adverse event (AE) reporting, AEs are under‐reported on clinical trials. We hypothesized that electronic medical record (EMR) data can ascertain laboratory‐based AEs ...more accurately than those ascertained manually. EMR data on 12 AEs for patients enrolled on two Children's Oncology Group (COG) trials at one institution were extracted, processed and graded. When compared to gold standard chart data, COG AE report sensitivity and positive predictive values (PPV) were 0–21·1% and 20–100%, respectively. EMR sensitivity and PPV were >98·2% for all AEs. These results demonstrate that EMR‐based AE ascertainment and grading substantially improves laboratory AE reporting accuracy.
Objective To assess preventive care measure prescribing in children exposed to glucocorticoids and identify prescribing variation according to subspecialty and patient characteristics. Study design ...Retrospective cohort study of children initiating chronic glucocorticoids in the gastroenterology, nephrology, and rheumatology divisions at a pediatric tertiary care center. Outcomes included 25-hydroxyvitamin D (25OHD) and lipid testing, pneumococcal polysaccharide (PPV) and influenza vaccination, and stress dose hydrocortisone prescriptions. Results A total of 701 children were followed for a median of 589 days. 25OHD testing was performed in 73%, lipid screening in 29%, and PPV and influenza vaccination in 16% and 78%, respectively. Hydrocortisone was prescribed in 2%. Across specialties, 25OHD, lipid screening, and PPV prescribing varied significantly (all P < .001). Using logistic regression adjusting for specialty, 25OHD testing was associated with older age, female sex, non-Hispanic ethnicity, and lower baseline height and body mass index z-scores (all P < .03). Lipid screening was associated with older age, higher baseline body mass index z-score, and lower baseline height z-score (all P < .01). Vaccinations were associated with lower age ( P < .02), and PPV completion was associated with non-White race ( P = .04). Conclusions Among children chronically exposed to glucocorticoids, 25OHD testing and influenza vaccination were common, but lipid screening, pneumococcal vaccination, and stress dose hydrocortisone prescribing were infrequent. Except for influenza vaccination, preventive care measure use varied significantly across specialties. Quality improvement efforts are needed to optimize preventive care in this high-risk population.
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