Management strategies for children with COVID-19: ESPR practical recommendations

Abstract

During the outbreak of the COVID-19 pandemic, guidelines have been issued by international, national and local authorities to address management and the need for preparedness. Children with COVID-19 differ from adults in that they are less often and less severely affected. Additional precautions required in the management of children address their increased radiosensitivity, need for accompanying carers, and methods for dealing with children in a mixed adult-paediatric institution. In this guidance document, our aim is to define a pragmatic strategy for imaging children with an emphasis on proven or suspected COVID-19 cases. Children suspected of COVID-19 should not be imaged routinely. Imaging should be performed only when expected to alter patient management, depending on symptoms, preexisting conditions and clinical evolution. In order to prevent disease transmission, it is important to manage the inpatient caseload effectively by triaging children and carers outside the hospital, rescheduling nonurgent elective procedures and managing symptomatic children and carers as COVID-19 positive until proven otherwise. Within the imaging department one should consider conducting portable examinations with COVID-19 machines or arranging dedicated COVID-19 paediatric imaging sessions and performing routine nasopharyngeal swab testing before imaging under general anaesthesia. Finally, regular personal hygiene, appropriate usage of personal protective equipment, awareness of which procedures are considered aerosol generating and information on how to best disinfect imaging machinery after examinations should be highlighted to all staff members.

Re: clinical characteristics and radiological features of children infected with the 2019 novel coronavirus

“…Moscow is a large city with high population density: in some districts, it reaches 30,500 people/km 2 , 3 which is higher than Manhattan, New York, with 27,544 people/ km 2 . 4 Given the reluctance of inhabitants to wear masks during the first weeks of the pandemic, grave consequences awaited Moscow. As of 8 June 2020, there were 197,018 patients with diagnosed COVID-19 in the city 5 (for comparison, the total number of cases in Italy was 235,278 2 ).…”

“…3 Recently, the European Society of Paediatric Radiology (ESPR) taskforce has written similar guidance echoing that imaging should not be used routinely for the diagnosis of COVID-19 in children, but reserved for cases where results are anticipated to alter the management. 4 We note that CT was recommended as the major evidence of clinical diagnosis in HuBei province by the National Health and Health Commission of China (5th edition). 5 It is unclear if this was targeted at the adult or paediatric population, but one would assume this was the former in view of the severity of disease in the adult versus the paediatric population.…”

“…3 Recently, the European Society of Paediatric Radiology (ESPR) taskforce has written similar guidance echoing that imaging should not be used routinely for the diagnosis of COVID-19 in children, but reserved for cases where results are anticipated to alter the management. 4 …”

COVID-19 in a pediatric cohort—retrospective review of chest computer tomography findings

“…Since in most pediatric patients the clinical presentation of COVID-19 disease is mild, balance between the risk of radiation and necessity for imaging should be evaluated [ 9 ]. Actually, imaging is only indicated for patients with moderate to severe acute respiratory illness symptoms or risk factors [ 8 , 11 , 12 ]. Also, CXR has been proven insensitive in mild or early COVID-19 disease [ 13 ].…”

“…The scarce literature on appropriateness criteria for imaging and for consensus on reporting CXR and CT findings in children has been challenging in defining pathways and management of patients with suspected COVID-19 disease in Pediatric Centres. While the Fleishner Society Consensus states that children merit separate consideration, particularly with regard to the use of radiation-associated procedures, further recommendations for this age group are scarce [ 11 , 12 ]. The International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management [ 8 ] (herein cited as “International Consensus”) clarified clinical severity, risk factors, and imaging recommendations in pediatric patients with COVID-19.…”