BACKGROUND: Little is known about the clinical factors associated with COVID-19 disease severity in children and adolescents.

METHODS: We conducted a retrospective cohort study across 45 US children’s hospitals between April 2020 to September 2020 of pediatric patients discharged with a primary diagnosis of COVID-19. We assessed factors associated with hospitalization and factors associated with clinical severity (eg, admission to inpatient floor, admission to intensive care unit [ICU], admission to ICU with mechanical ventilation, shock, death) among those hospitalized.

RESULTS: Among 19,976 COVID-19 encounters, 15,913 (79.7%) patients were discharged from the emergency department (ED) and 4063 (20.3%) were hospitalized. The clinical severity distribution among those hospitalized was moderate (3222, 79.3%), severe (431, 11.3%), and very severe (380, 9.4%). Factors associated with hospitalization vs discharge from the ED included private payor insurance (adjusted odds ratio [aOR],1.16; 95% CI, 1.1-1.3), obesity/type 2 diabetes mellitus (type 2 DM) (aOR, 10.4; 95% CI, 8.9-13.3), asthma (aOR, 1.4; 95% CI, 1.3-1.6), cardiovascular disease, (aOR, 5.0; 95% CI, 4.3-5.8), immunocompromised condition (aOR, 5.9; 95% CI, 5.0-6.7), pulmonary disease (aOR, 5.3; 95% CI, 3.4-8.2), and neurologic disease (aOR, 3.2; 95% CI, 2.7-5.8). Among children and adolescents hospitalized with COVID-19, greater disease severity was associated with Black or other non-White race; age greater than 4 years; and obesity/type 2 DM, cardiovascular, neuromuscular, and pulmonary conditions.

CONCLUSIONS: Among children and adolescents presenting to US children’s hospital EDs with COVID-19, 20% were hospitalized; of these, 21% received care in the ICU. Older children and adolescents had a lower risk for hospitalization but more severe illness when hospitalized. There were differences in disease severity by race and ethnicity and the presence of selected comorbidities. These factors should be taken into consideration when prioritizing mitigation and vaccination strategies.

背景：对于与儿童和青少年 COVID-19 疾病严重程度相关的临床因素知之甚少。

方法：我们在 2020 年 4 月至 2020 年 9 月期间对 45 家美国儿童医院进行了一项回顾性队列研究，研究对象为初步诊断为 COVID-19 的出院儿科患者。我们评估了住院患者中与住院相关的因素和与临床严重程度相关的因素（例如，入住住院楼层、入住重症监护病房 [ICU]、入住 ICU 进行机械通气、休克、死亡）。

结果：在 19,976 例 COVID-19 病例中，15,913 例 (79.7%) 患者从急诊室 (ED) 出院，4063 例 (20.3%) 住院。住院患者的临床严重程度分布为中度（3222, 79.3%）、重度（431, 11.3%）和极重度（380, 9.4%）。与住院与出院相关的因素包括私人支付保险（调整优势比 [aOR]，1.16；95% CI，1.1-1.3）、肥胖/2 型糖尿病（2 型糖尿病）（aOR，10.4；95% CI, 8.9-13.3), 哮喘 (aOR, 1.4; 95% CI, 1.3-1.6), 心血管疾病, (aOR, 5.0; 95% CI, 4.3-5.8), 免疫功能低下 (aOR, 5.9; 95% CI, 5.0-6.7)、肺部疾病 (aOR, 5.3; 95% CI, 3.4-8.2) 和神经系统疾病 (aOR, 3.2; 95% CI, 2.7-5.8)。在因 COVID-19 住院的儿童和青少年中，更大的疾病严重程度与黑人或其他非白人种族有关；年龄大于 4 岁；和肥胖/2 型糖尿病、心血管、神经肌肉和肺部疾病。

结论：在美国儿童医院急诊室就诊的 COVID-19 儿童和青少年中，20% 住院；其中，21% 在 ICU 接受治疗。年龄较大的儿童和青少年住院的风险较低，但住院时病情更严重。种族和民族的疾病严重程度以及选定的合并症的存在存在差异。在优先考虑缓解和疫苗接种策略时，应考虑这些因素。