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OBJECTIVE To describe the impact of obesity on disease severity and outcomes of coronavirus disease 2019 (COVID-19) among hospitalized children. METHODS This retrospective cohort study from the Society of Critical Care Medicine Viral Respiratory Illness Universal Study registry included all children hospitalized with COVID-19 from March 2020 to January 2021. Obesity was defined by Centers for Disease Control and Prevention BMI or World Health Organization weight for length criteria. Critical illness definition was adapted from National Institutes of Health criteria of critical COVID. Multivariate mixed logistic and linear regression was performed to calculate the adjusted odds ratio of critical illness and the adjusted impact of obesity on hospital length of stay. RESULTS Data from 795 patients (96.4% United States) from 45 sites were analyzed, including 251 (31.5%) with obesity and 544 (68.5%) without. A higher proportion of patients with obesity were adolescents, of Hispanic ethnicity, and had other comorbidities. Those with obesity were also more likely to be diagnosed with multisystem inflammatory syndrome in children (35.7% vs 28.1%, P = .04) and had higher ICU admission rates (57% vs 44%, P < .01) with more critical illness (30.3% vs 18.3%, P < .01). Obesity had more impact on acute COVID-19 severity than on multisystem inflammatory syndrome in children presentation. The adjusted odds ratio for critical illness with obesity was 3.11 (95% confidence interval: 1.8–5.3). Patients with obesity had longer adjusted length of stay (exponentiated parameter estimate 1.3; 95% confidence interval: 1.1–1.5) compared with patients without obesity but did not have increased mortality risk due to COVID-19 (2.4% vs 1.5%, P = .38). CONCLUSION In a large, multicenter cohort, a high proportion of hospitalized children from COVID-19 had obesity as comorbidity. Furthermore, obesity had a significant independent association with critical illness.

WHAT'S KNOWN ON THIS SUBJECT: Injuries sustained by children in the school setting have a significant public health impact. A concerning subgroup of school injuries are due to intentional and violent etiologies. Several studies have identified a need for further research to understand intentional school-based injuries. WHAT THIS STUDY ADDS:This study discusses national estimates and trends over time and risk factors of intentional injury-related emergency department visits due to injuries sustained in the school setting. abstract BACKGROUND AND OBJECTIVE: Previous studies have reported concerning numbers of injuries to children in the school setting. The objective was to understand temporal and demographic trends in intentional injuries in the school setting and to compare these with intentional injuries outside the school setting. METHODS:Data from the National Electronic Injury Surveillance SystemAll Injury Program from 2001 to 2008 were analyzed to assess emergency department visits (EDVs) after an intentional injury. RESULTS:There were an estimated 7 397 301 total EDVs due to injuries sustained at school from 2001 to 2008. Of these, an estimated 736 014 (10%) were reported as intentional (range: 8.5%-10.7% for the study time period). The overall risk of an EDV after an intentional injury in school was 2.33 (95% confidence interval [CI]: 1.93-2.82) when compared with an EDV after an intentional injury outside the school setting. For intentional injury-related EDVs originating in the school setting, multivariate regression identified several demographic risk factors: 10-to 14-year-old (odds ratio [OR]: 1.58; 95% CI: 1.10-2.27) and 15-to 19-year-old (OR: 1.69; 95% CI: 1.01-2.82) age group, black (OR: 4.14; 95% CI: 2.94-5.83) and American Indian (OR: 2.48; 95% CI: 2.06-2.99) race, and Hispanic ethnicity (OR: 3.67; 95% CI: 2.02-6.69). The odds of hospitalization resulting from intentional injury-related EDV compared with unintentional injury-related EDVs was 2.01 (95% CI: 1.50-2.69) in the school setting. These odds were found to be 5.85 (95% CI: 4.76-7.19) in the outside school setting. CONCLUSIONS:The findings of this study suggest a need for additional prevention strategies addressing school-based intentional injuries.