A cross-sectional study of screening for coronavirus disease 2019 (COVID-19) at the pediatric emergency department in Vilnius during the first wave of the pandemic
- 25 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Journal of Pediatrics
- Vol. 180 (7), 2137-2145
- https://doi.org/10.1007/s00431-021-03999-z
Abstract
Screening for COVID-19 is based on clinical and epidemiological factors. Children infected with SARS-CoV-2 may have a few or many non-specific symptoms or may be asymptomatic. The aim of this study was to analyze clinical features and exposure to SARS-CoV-2 characteristics of children screened for COVID-19 at the pediatric emergency department in Vilnius during the first 3 months (March–May) of the COVID-19 pandemic in Lithuania. SARS-CoV-2 PCR was positive for 0.6% (8/1348) of all screened children and for 0.9% (7/811) of symptomatic patients, more among children with fever and cough (2.6%, 4/154). There were also COVID-19 cases among children without cough but with other respiratory symptoms (0.5%, 2/409) or gastrointestinal symptoms (1.2%, 3/257). Only one child with positive SARS-CoV-2 did not meet COVID-19 clinical criteria—he presented with vomiting and dehydration only. All COVID-19 cases (n = 8) had a contact with a confirmed COVID-19 family member. There were no COVID-19 cases among children without known exposure to SARS-CoV-2 or among asymptomatic children. Conclusion: Screening for COVID-19 in children is exceptionally challenging due to the diverse and non-specific symptoms of infection they present. Testing strategies should not only focus on the typical COVID-19 symptoms of fever or cough, but also include other symptoms, especially gastrointestinal symptoms, which are also important. The greatest attention should be paid to known exposure to SARS-CoV-2, especially in family clusters. Screening of asymptomatic children with no known exposure should be weighed for medical necessity and cost-effectiveness. What is Known: • Diagnosis of COVID-19 in children is challenging because the disease does not always manifest with typical symptoms. What is New: • Children in our study who did not have symptoms of acute infection and contact with another person infected with COVID-19 were not diagnosed with COVID-19, so the benefit of PCR testing is questionable. Such testing may only be useful for infection control purposes, and to limit intra-hospital transmission.Keywords
This publication has 14 references indexed in Scilit:
- Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, SpainJAMA Pediatrics, 2021
- Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New YorkJAMA Pediatrics, 2020
- COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort studyThe Lancet Child & Adolescent Health, 2020
- A systematic review and meta‐analysis of children with coronavirus disease 2019 (COVID‐19)Journal of Medical Virology, 2020
- Systematic Severe Acute Respiratory Syndrome Coronavirus 2 Screening at Hospital Admission in Children: A French Prospective Multicenter StudyClinical Infectious Diseases, 2020
- Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, ChinaJAMA Pediatrics, 2020
- Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020Morbidity and Mortality Weekly Report (MMWR), 2020
- Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight childrenThe Lancet Child & Adolescent Health, 2020
- Review article: gastrointestinal features in COVID‐19 and the possibility of faecal transmissionAlimentary Pharmacology & Therapeutics, 2020