(131) Children with COVID-19: The Real-World Hospital Experience

Publication Number: 805

Background: Evolving COVID-19 treatment guidelines have been targeted towards adults due to insufficient data available in the pediatric population. Additionally, patient characteristics and outcomes among hospitalized COVID-19 patients have been well described in adults. The real-world COVID-19 hospital experience among the pediatric population is not well understood.

Objectives: The objective of this research is to characterize real-world treatment patterns and outcomes in pediatric patients hospitalized with COVID-19 in a diverse set of healthcare settings.

Methods: Pediatric patients from 4 integrated delivery networks in the OMNY Health Database with an encounter for COVID-19 were included. Patients were characterized at diagnosis. Percentages of patients with prescriptions/administrations for therapies mentioned in the National Institutes of Health (NIH) treatment guidelines for adults were computed. Outcomes of interest included length of stay (LOS), gross charges, discharge disposition, and inpatient mortality. Results were stratified by treatment setting.

Results: A total of 3,526 patients (51% female, 50% ages ≤ 10 years, 50%/27%/22% White/Black/Other) diagnosed in the outpatient/observation (OP; 32%), emergency department (ED; 53%), inpatient (IP; 8%), and unspecified (UN; 7%) settings were included. Aside from remdesivir, which was administered to 20% of patients in the IP setting, other antiviral therapy use was negligible. COVID-19 antibody products were used in < 10% of patients across all settings. Dexamethasone was used in 31%/7%/2% of patients in the IP/ED/OP settings. Adjunctive vitamin and antithrombotic therapies were given to 18% and 11% of patients, respectively, in the IP setting. Mean (median) LOS was 1.6 days (1 day) and gross charges were $16,979 ($1,758). The most common discharge dispositions were home/self-care (93%) and discharge to acute care facility (1%). Inpatient mortality was 0.11% (4/3,526).

Conclusions: These results help provide insights into real-world hospital experience of pediatric patients with COVID-19. Observed treatment patterns in children generally aligned with the NIH guidelines for adults. As expected, most therapies were prescribed/administered in the IP setting, followed by the ED and OP settings. Outcome metrics of LOS, gross charges, and inpatient mortality were more favorable than those regularly reported among adult populations. Additional analyses as treatment guidelines evolve would be insightful to elucidate changing patient characteristics, treatment patterns, and outcomes.