International Analysis of Electronic Health Records of Children and Youth Hospitalized With COVID-19 Infection in 6 Countries.
International Analysis of Electronic Health Records of Children and Youth Hospitalized With COVID-19 Infection in 6 Countries.
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DOI：
10.1001/jamanetworkopen.2021.12596
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
Consortium for Clinical Characterization of COVID-19 by EHR (4CE)
中科院分区：
文献类型：
--
作者：
Bourgeois FT;Gutiérrez-Sacristán A;Keller MS;Liu M;Hong C;Bonzel CL;Tan ALM;Aronow BJ;Boeker M;Booth J;Cruz Rojo J;Devkota B;García Barrio N;Gehlenborg N;Geva A;Hanauer DA;Hutch MR;Issitt RW;Klann JG;Luo Y;Mandl KD;Mao C;Moal B;Moshal KL;Murphy SN;Neuraz A;Ngiam KY;Omenn GS;Patel LP;Jiménez MP;Sebire NJ;Balazote PS;Serret-Larmande A;South AM;Spiridou A;Taylor DM;Tippmann P;Visweswaran S;Weber GM;Kohane IS;Cai T;Avillach P;Consortium for Clinical Characterization of COVID-19 by EHR (4CE)
这项队列研究旨在描述新冠肺炎患者的国际住院趋势以及儿童和青年的主要流行病学和临床特征。感染SARS-CoV-2的儿童和青少年住院治疗的国际趋势是什么？这些患者的流行病学和临床特征是什么？这项对671名儿童和青年进行的队列研究发现，不同国家的住院人数出现了离散的激增，其趋势和时间各不相同。常见的并发症包括心律失常和病毒性肺炎，实验室发现包括炎症标志物和凝血异常的升高；很少有儿童和青年接受专门针对SARS-CoV-2的药物治疗。这些发现表明，用于在医疗保健系统中整合电子健康记录数据的大规模基于信息学的方法可以提供有效的信息来源，以监测疾病活动并确定因SARS-CoV-2感染住院的儿科患者的流行病学和临床特征。需要更多的儿科流行病学和临床数据来源，以有效地研究儿童和青年中的新冠肺炎，并为儿科患者的感染预防和临床治疗提供信息。描述新冠肺炎在国际上的住院趋势以及儿童和青年的主要流行病学和临床特征。这项回顾性队列研究包括2020年2月2日至10月10日期间住院的儿科患者。在法国、德国、西班牙、新加坡、英国和美国的27家医院收集了患者级别的电子健康记录(EHR)数据。这项研究包括了21岁以下的新冠肺炎检测呈阳性并在一家机构住院的患者，该机构参与了EHR对新冠肺炎的临床特征描述联盟。患者特征、临床特征和用药情况。在本研究的队列中，有347名男性(52%；95%CI，48.5-55.3)和324名女性(48%；95%CI，44.4-51.3)。年龄分布呈双峰分布，0至2岁(199名患者[30%])和12至17岁(170名患者[25%])的患者比例最大。671名儿童和青少年的住院趋势发现，6个国家的住院人数出现了离散的激增，时间长短不一。这一队列的数据反映了大多数有数据的国家的国家一级儿科住院趋势，在国家一级和4CE数据中，在最初的春季高峰期间的住院高峰出现在23天内。分析了16个实验室检测的27个 364化验值，平均值表明炎症标志物(C-反应蛋白，83 mg/L；95%可信区间，53-112 mg/L；铁蛋白，417 ng/mL；95%可信区间，228-607 ng/mL；降钙素原，1.45 ng/mL；95%可信区间，0.13-2.77 ng/mL)升高。凝血功能异常也很明显(D-二聚体0.78微克/毫升；95%可信限0.35-1.21微克/毫升；纤维蛋白原，477毫克/分升；95%可信限385-569毫克/毫升)。检查时(n = 59)，心肌肌钙蛋白升高(0.032 ng/mL；95%CI，0.000-0.080 ng/mL)。常见并发症包括心律失常(15.0%；95%CI，8.1%~21.7%)、病毒性肺炎(13.3%；95%CI，6.5%~20.1%)和呼吸衰竭(10.5%；95%CI，5.8%~15.3%)。很少有儿童接受新冠肺炎指导的药物治疗。这项对6个国家和地区因新冠肺炎住院的儿童和青年的EHR研究表明，各国的住院趋势存在差异，并确定了新冠肺炎感染儿童和青年的常见并发症和实验室异常。以信息学为基础的大规模方法来整合和分析医疗保健系统中的数据，是对疾病监测方法的补充，并增进了对儿童和青年中与新冠肺炎相关的流行病学和临床特征的了解。
This cohort study aims to describe international hospitalization trends and key epidemiological and clinical features of children and youth with COVID-19. What are international trends in hospitalizations for children and youth with SARS-CoV-2, and what are the epidemiological and clinical features of these patients? This cohort study of 671 children and youth found discrete surges in hospitalizations with variable trends and timing across countries. Common complications included cardiac arrhythmias and viral pneumonia, and laboratory findings included elevations in markers of inflammation and abnormalities of coagulation; few children and youth were treated with medications directed specifically at SARS-CoV-2. These findings suggest large-scale informatics-based approaches used to incorporate electronic health record data across health care systems can provide an efficient source of information to monitor disease activity and define epidemiological and clinical features of pediatric patients hospitalized with SARS-CoV-2 infections. Additional sources of pediatric epidemiological and clinical data are needed to efficiently study COVID-19 in children and youth and inform infection prevention and clinical treatment of pediatric patients. To describe international hospitalization trends and key epidemiological and clinical features of children and youth with COVID-19. This retrospective cohort study included pediatric patients hospitalized between February 2 and October 10, 2020. Patient-level electronic health record (EHR) data were collected across 27 hospitals in France, Germany, Spain, Singapore, the UK, and the US. Patients younger than 21 years who tested positive for COVID-19 and were hospitalized at an institution participating in the Consortium for Clinical Characterization of COVID-19 by EHR were included in the study. Patient characteristics, clinical features, and medication use. There were 347 males (52%; 95% CI, 48.5-55.3) and 324 females (48%; 95% CI, 44.4-51.3) in this study’s cohort. There was a bimodal age distribution, with the greatest proportion of patients in the 0- to 2-year (199 patients [30%]) and 12- to 17-year (170 patients [25%]) age range. Trends in hospitalizations for 671 children and youth found discrete surges with variable timing across 6 countries. Data from this cohort mirrored national-level pediatric hospitalization trends for most countries with available data, with peaks in hospitalizations during the initial spring surge occurring within 23 days in the national-level and 4CE data. A total of 27 364 laboratory values for 16 laboratory tests were analyzed, with mean values indicating elevations in markers of inflammation (C-reactive protein, 83 mg/L; 95% CI, 53-112 mg/L; ferritin, 417 ng/mL; 95% CI, 228-607 ng/mL; and procalcitonin, 1.45 ng/mL; 95% CI, 0.13-2.77 ng/mL). Abnormalities in coagulation were also evident (D-dimer, 0.78 ug/mL; 95% CI, 0.35-1.21 ug/mL; and fibrinogen, 477 mg/dL; 95% CI, 385-569 mg/dL). Cardiac troponin, when checked (n = 59), was elevated (0.032 ng/mL; 95% CI, 0.000-0.080 ng/mL). Common complications included cardiac arrhythmias (15.0%; 95% CI, 8.1%-21.7%), viral pneumonia (13.3%; 95% CI, 6.5%-20.1%), and respiratory failure (10.5%; 95% CI, 5.8%-15.3%). Few children were treated with COVID-19–directed medications. This study of EHRs of children and youth hospitalized for COVID-19 in 6 countries demonstrated variability in hospitalization trends across countries and identified common complications and laboratory abnormalities in children and youth with COVID-19 infection. Large-scale informatics-based approaches to integrate and analyze data across health care systems complement methods of disease surveillance and advance understanding of epidemiological and clinical features associated with COVID-19 in children and youth.
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