Clinical Characteristics and Outcomes of Pediatric Patients with Confirmed or Suspected COVID-19 within a Large Public Hospital System

Background: Children mostly exhibit non-specific symptoms and are at a lower risk of severe disease from COVID-19. The objective of the study was to describe the demographic, clinical features, and outcomes of children, stratified by age, with a laboratory confirmed or suspected diagnosis of COVID-19.Methods: A cross-sectional study was conducted within a large safety-net public hospital system in Phoenix, Arizona, during the pandemic’s summer surge (March 15th – September 30th, 2020). Children (0-<18 years) undergoing molecular testing for SARS-CoV-2 were included. Detailed review of hospital records was done. The association between SARS-CoV-2 test positivity and presenting complaints were examined. Also, the relationship between hospitalization and demographic characteristics, COVID-19 test positivity, triage temperature, and primary discharge diagnosis was explored. Findings: 1,032 children underwent testing for the SARS-CoV-2 during the study period. Mean age was 9.7 (SD + 6.0) years, 50% were male, and majority were Hispanic (74%). Overall test positivity rate was 21.3%. Test positivity was significantly higher in children reporting Hispanic ethnicity or Asian racial background compared with other race/ethnic groups. Among children with an ED visit (N=369), there was no significant association between common presenting complaints and test positivity. However, in children with loss of taste and/or smell 83% tested positive for COVID-19. Pneumonia and Multisystem Inflammatory Syndrome in Children (MIS-C) significantly increased the likelihood of hospitalization (Pneumonia: OR, 7.6 [95% CI, 2.4-23.6]; MIS-C: OR, 46.8 [95% CI, 4.9-444.3]). No deaths were reported.Interpretation: COVID-19 has a milder disease manifestation in children with most cases managed in an outpatient setting. Loss of taste and/or smell is highly predictive of SARS-CoV-2 test positivity; however, test positivity is not predictive of a need for hospitalization.Funding: All phases of this study was supported by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases.Declaration of Interests: The authors have no conflicts of interest relevant to this article to disclose.Ethics Approval Statement: The study was approved by the Institutional Review Board of the Valleywise Health, Phoenix AZ.