BACKGROUND: Estimates of pediatric morbidity and mortality from COVID-19 are vital for planning optimal use of human and material resources throughout this pandemic. METHODS:Government websites from countries with minimum 1000 cases in adults and children on April 13, 2020 were searched to find the number of cases confirmed in children, the age range, and the number leading to hospitalization, intensive care unit (ICU) admission or death. A systematic literature search was performed April 13, 2020 to find additional data from cases series. RESULTS:Data on pediatric cases were available from government websites for 23 of the 70 countries with minimum 1000 cases by April 13, 2020. Of 424 978 cases in these 23 countries, 8113 (1.9%) occurred in children. Nine publications provided data from 4251 cases in 4 additional countries. Combining data from the websites and the publications, 330 of 2361 cases required admission (14%). The ICU admission rate was 2.2 % of confirmed cases (44 of 2031) and 7.2% of admitted children (23 of 318). Death was reported for 15 cases. CONCLUSION:Children accounted for 1.9% of confirmed cases. The true incidence of pediatric infection and disease will only be known once testing is expanded to individuals with less severe or no symptoms. Admission rates vary from 0.3 to 10% of confirmed cases (presumably varying with the threshold for testing) with about 7% of admitted children requiring ICU care. Death is rare in middle and high income countries.
A bdominal pain is reported by a third of school-aged children 1 and accounts for several visits daily in most emergency departments. 2-5 Although the use of analgesia to treat acute abdominal pain is well-supported, 6,7 there is little evidence to guide the management of nonspecific abdominal pain in the emergency department, 8 which accounts for two-thirds of cases of abdominal pain presenting to the emergency department. 8,9 Acetaminophen is the most commonly used World Health Organization Step 1 analgesic. 10 In children, it is effective for many painful conditions, 11,12 but data supporting its use for abdominal pain are lacking. 13,14 Despite strong advocacy by the American Academy of Pediatrics 15 for adequate pain management, less than two-thirds of children with abdominal pain in the emergency department receive analgesia, 16,17 and roughly half experience ongoing pain after discharge. 18 Children with nonspecific abdominal pain are less likely than those with a specific cause to receive analgesia. 5 Available analgesic options for children with nonspecific abdominal pain in the emergency department may result in greater adherence to the American Academy of Pediatrics recommendations. Hyoscine butylbromide is orally administered and available in most Canadian emergency departments. We surmised that it may be effective for colicky abdominal pain owing to its antispasmodic properties. 19 Ten placebo-controlled studies involving 3699 adults with functional abdominal pain showed hyoscine butylbromide to be beneficial, without serious adverse effects. 20-29 In the only pediatric study, hyoscine butylbromide, 10 mg given orally, was found
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