Clinical and Laboratory Features of PCR-Confirmed and Clinically Suspected COVID-19 Pediatric Patients: A Single Hospital-Based Experience During the First COVID-19 Wave in the United Arab Emirates

Abstract

ObjectiveThis study investigated clinical and laboratory differences between confirmed (RT-PCR-positive) and clinically suspected (RT-PCR-negative) COVID-19 pediatric patients, and explored factors associated with disease severity at presentation and duration of hospitalization.MethodsMedical charts of COVID-19-confirmed and clinically suspected pediatric patients admitted to a tertiary hospital in Abu Dhabi were reviewed. Sociodemographic information and clinical and laboratory outcomes were retrieved and analyzed.ResultsBetween 1 April to 30 June, 2020, 173 patients (mean age: 3.6 ± SD 3.2 years) presented with respiratory symptoms. Of them, 18.0% had confirmed contact with COVID-19 cases, 66.5% had symptoms for ≤3 days, and 86.7% were with moderate to severe disease. Twenty-eight (16.1%) patients tested positive while the rest (83.8%) tested negative in RT-PCR. COVID-19-confirmed and clinically suspected patients were statistically similar (p > 0.05) in all sociodemographic data, disease severity, and vital signs except residence status (89.3% vs. 58.6% were residents, respectively, p = 0.002) and contact with confirmed COVID-19 cases (82.1% vs. 5.5%, respectively, p < 0.001). Fever (100 and 91.0%) and cough (100 and 95.9%) were the most common symptoms in both confirmed and clinically suspected COVID-19 patients. All patients were statistically comparable in mean white blood cell and platelet counts and hemoglobin concentration, except in mean concentration of neutrophils (higher in clinically suspected, p = 0.019). C-reactive protein was two times higher in clinically suspected compared to confirmed patients (p = 0.043). Lymphocyte (OR: 1.31, p < 0.001), LDH (OR: 1.01, p = 0.001), D-dimer (OR: 1.92, p < 0.001), and ferritin levels after 24–36 h (OR: 9.25, p < 0.05), and SGPT (OR: 1.04, p < 0.05) were all associated with disease severity. Elevated ferritin (>300 μg/L) after 24–36 h was the only correlated factor with disease severity (aOR: 17.38, p < 0.05). Confirmed compared with clinically suspected patients (aOR: 4.00, 95% CI: 2.92–5.10) and children with moderate compared with mild disease (aOR: 5.87, 95% CI: 1.08–32.06) had longer hospitalization.ConclusionIn pediatric patients with negative RT-PCR, COVID-19 is still suspected based on clinical symptoms and epidemiological data. A tentative diagnosis can be made based on a thorough examination, and proper medical management can be initiated promptly.

COVID-19 in Children: A Review of Epidemiology, Mode of Transmission, Clinical Presentation, Diagnosis, and Management

“…C-reactive protein was higher in clinically suspected compared to confirmed patients. Lymphocyte, Lactate Dehydrogenase (LDH), D-dimer, ferritin levels after 24-36 hours, and Serum Glutamic Pyruvic Transaminase (SGPT) were associated with disease severity [9]. Also, a study that included over 10,000 hospitalized children found that abnormal markers of inflammation, including D-dimers and ferritin, were associated with severe disease in children [3].…”

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“…C-reactive protein was higher in clinically suspected compared to confirmed patients. Lymphocyte, Lactate Dehydrogenase (LDH), D-dimer, ferritin levels after 24-36 hours, and Serum Glutamic Pyruvic Transaminase (SGPT) were associated with disease severity [9]. Also, a study that included over 10,000 hospitalized children found that abnormal markers of inflammation, including D-dimers and ferritin, were associated with severe disease in children [3].…”