Medical Director, Pediatric Emergency Department Penn State Health Hershey Medical Center Penn State Health Hershey Medical Center Hershey, Pennsylvania, United States
Background: Identification of patients with possible COVID-19 infection on arrival to an emergency department is essential for infection control. Symptom based screening can be challenging in young children and may not identify all infections due to asymptomatic cases.
Objective: To evaluate the effectiveness of a screening questionnaire for identification of COVID-19 infection in children of different ages.
Design/Methods: A retrospective study of children <18yrs of age seen in a pediatric ED was conducted from 9/1/2020 – 12/31/2020. A screening questionnaire was administered on arrival to the emergency department and was considered positive if the patient reported: 1) cough or shortness of breath, 2) two or more of the following symptoms – fever, shaking chills, muscle pain, headache, sore throat, loss of taste or smell, or diarrhea, 3) recent exposure to COVID-19, or 4) known COVID-19 infection. Sensitivity and specificity for identifying COVID-19 infection (defined by a positive test) were calculated and analyzed for patients aged 0-2 years and 3+ years of age.
Results: During the study period, there were 4373 ED encounters of which 4214 (96.4%) had documentation of a completed screening questionnaire. The screening questionnaire was positive for 967 ED encounters (22.9%), and children were positive for COVID-19 infection for 122 encounters. For the 967 encounters with positive screening questionnaires, 577 were tested for COVID-19 infection with PCR. Overall, 8.5% of COVID-19 PCR tests from the pediatric ED were positive. The sensitivity and specificity of the questionnaire was 75.5% and 71.4% for children aged 0-2 years versus 84.1% and 82.1% in children aged 3+ years, respectively. The screening questionnaire did not identify 13 children aged 0-2 years with COVID-19 infection and 11 children aged 3+ years. The majority of COVID-19 positive patients missed by the screening questionnaire were symptomatic, including with fever or vomiting. Conclusion(s): During a period of significant community spread of COVID-19 infection, a screening questionnaire based on symptoms and COVID-19 exposure fails to identify a number of children with COVID-19 infection. This particular questionnaire performed less accurately in young children; screening approaches should account for the presentation of COVID-19 infection in young children and the inability to express specific symptoms of COVID-19 infection like loss of taste or smell.
Authors/Institutions: Kathryn E. Kasmire, Penn State Health Hershey Medical Center, Hershey, Pennsylvania, United States