Universal Screening for SARS-CoV-2 in Children Undergoing Surgery: A Multicenter Report

Background/Purpose: As the COVID-19 pandemic continues to spread worldwide, children may account for only 2.16% of confirmed cases. Previous studies may underestimate the true incidence of COVID-19 in children as they are more likely to be asymptomatic, and thereby less likely to be tested. We aimed to determine the incidence of COVID-19 in pediatric patients presenting for surgery.

Methods: After universal preoperative screening for COVID-19 was instituted at the Children’s Hospital of Philadelphia, Seattle Children’s, and Texas Children’s Hospital, children <19 years age without known COVID-19 were tested using a reverse-transcriptase polymerase chain reaction (RT-PCR) assay to detect the SARS-CoV-2 virus. Patient characteristics were evaluated to determine factors associated with positive testing.

Results: 1,295 pediatric surgical patients were screened (mean age 7.35 years). The overall incidence of COVID-19 was 0.93% (12/1,295), but ranged from 0.22% to 2.65% across hospitals (p=0.001). At one institution, 5/9 positive patients presented from a single township with a positive risk rate of 55.6% vs. 1.51% in all other patients (p=0.001). 50% of COVID-19 patients presented with preoperative symptoms vs.12.24% in negative patients (p=0.002) (Table 1). Fever (25.0% vs. 6.7%, p=0.044), rhinorrhea (16.7% vs. 2.8%, p=0.005), and known COVID-19 exposure (20.0% vs. 1.7%, p=0.014) were more common in COVID-19 patients. After multivariate regression, age (OR 1.10, p=0.048) and ASA emergent classification (OR 5.66, p=0.001) were associated with COVID-19.

Conclusion: The overall incidence of COVID-19 in children undergoing preoperative universal screening was <1%. However, this varied greatly between the regions represented by our hospitals, and even by township within the catchment area of a single hospital. The value of universal COVID-19 screening appears greatest in areas with higher prevalence. As elective surgery resumes, it will be important to consider universal testing in the context of regional prevalence, local testing capability, and availability of personal protective equipment.