key: cord-0960345-ea1ehsnq
authors: Assaker, Rita; Colas, Anne-Emmanuelle; Julien-Marsollier, Florence; Bruneau, Béatrice; Marsac, Lucile; Greff, Bruno; Tri, Nathalie; Fait, Charlotte; Brasher, Christopher; Dahmani, Souhayl
title: Presenting symptoms of COVID-19 in children: a meta-analysis of published studies
date: 2020-05-31
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.05.026
sha: 97927eea8581f024f5f474d094a68f5368a59504
doc_id: 960345
cord_uid: ea1ehsnq

nan

Keywords: clinical signs, clinical presentation, COVID-19, meta-analysis, paediatrics, symptomes Editor -The COVID-19 pandemic has led to drastic changes in the structure of clinical care worldwide (1) . During the rising phase of the epidemic spread, health systems are being overwhelmed by critically ill COVID-19 patients (2) . Once the peak of COVID-19 cases has passed, delayed medical and surgical care will become a priority. The high transmission rate This meta-analysis was registered (https://osf.io/3u8nh) and was performed according to the Cochrane Handbook for Systematic Reviews guidelines a . Literature searches included PubMed and Embase. The following key word associations were entered ["COVID-19" or "Sars-Cov2" or "Sars-Cov-2"] and "Children". The most recent search was performed on May 3, 2020. Articles with the following criteria were selected: studies describing paediatric patients suffering from COVID-19, confirmatory diagnosis using RT-qPCR, including a description of the country in which the study was performed, details about COVID-19 suspicion criteria (symptoms and/or contact with a sick person) and details of clinical signs and symptoms and CT scan results. Articles describing patient clusters or case reports of less than two patients were excluded from the analysis. Given that the pandemic will continue across seasons and overlap with peak influenza periods, it will be difficult to distinguish symptomatic paediatric COVID-19 patients from patients with influenza.

In our analysis, 16% of SARS-CoV-2-infected paediatric patients were asymptomatic.

This proportion of asymptomatic patients is very likely a representation of RT-qPCR testing following contact. Asymptomatic patients have been estimated to represent 85% of infected patients in the general population (6) , and a recent study in pregnant women found 13.5 % of asymptomatic patients with a positive RT-qPCR test (7) . Consequently, in the context of community SARS-CoV-2 spread, generalized population-based screening using RT-qPCR appears the most effective strategy for detecting SARS-CoV-2 infected paediatric patients with no clinical signs or known contacts.

Our results are of particular interest when considering the future management of hospitalized patients. There is a good case to be made for screening all hospital inpatients, or at least considering a strategy relying on a careful screening of patients for clinical signs and/or a recent contact with an infected person followed by a RT-qPCR confirmation.

However, one must also keep in mind that a negative result is no guarantee of the absence of infection. Studies have shown that RT-qPCT test sensitivity averages 70% when samples were taken from the nasopharynx (8) . Therefore, any patient with a high index of suspicion of COVID-19 should be treated as such in terms of protective measures, even where the RT-qPCR is negative. Radiological findings have shown promise as diagnostic tests for COVID-19 in adult patients (3) . In children, according to our results, typical CT changes were present in just 55% of patients and indicates that CT scanning is of lesser value in children compared to adults.

In conclusion, our meta-analysis sheds light on (a) the absence of specificity regarding COVID-19 symptoms in children and (b) the relatively high proportion of asymptomatic patients. Our results should be considered when policy is determined for detecting Sars-Cov-2 infection in children in the context of the medical and surgical management.

The authors declare no conflicts of interest. Table 1 : Analysis of primary and secondary outcomes of the meta-analysis. Results are expressed as mean percentages [95 % Confidence Interval]. I² : heterogeneity of the result and p : level of significance of the heterogeneity. * Classification of severity was based on Dong and colleagues (5) .

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