Executive Vice Chair UC Davis School of Medicine University of California Davis School of Medicine Sacramento, California, United States
Background: Evidence supports high rates of asymptomatic infections with Coronavirus of 2019 (COVID-19), leading to concerns that viral transmission may occur via these asymptomatic patients.
Objective: Our objective was to describe the utility of screening for COVID-19 in asymptomatic pediatric emergency department (ED) patients. We hypothesized that asymptomatic testing has low yield when the community prevalence is low.
Design/Methods: This was a retrospective cohort study of data collected from the study site’s electronic health record. We included all pediatric ED patients (<18 years) who had a COVID-19 test obtained via the ED’s asymptomatic COVID-19 screening protocol. The protocol screened all pediatric ED admissions, surgical procedures and psychiatry placements. Testing was performed by reverse transcriptase polymerase chain reaction, using samples obtained from nasopharyngeal swabs. The primary outcome was positive COVID-19 tests. Patients with positive tests underwent further data abstraction using standard chart review methodology and were considered to have signs or symptoms of COVID-19 if any of the following were documented in the ED or admission note: fever, hypoxia, cough, fatigue, myalgias, nasal congestion/drainage, shortness of breath, sore throat, headache, diarrhea, or loss of taste/smell. Data from the Sacramento County COVID-19 website was used to estimate daily COVID-19 cases/100,000 individuals (from all ages). Data were described with simple descriptive statistics.
Results: 1,028 children had a COVID-19 test ordered under the asymptomatic protocol. The mean age was 8.2 ± 5.8 years. Two tests were inconclusive and 9 (0.9%, 95%CI 0.4-1.7) were positive. On the seven days that asymptomatic cases were identified, the community rate ranged from 4.86 to 18.40 cases/100,000 individuals. Of the 9 positive cases, 5 (56%, 95%CI 21-86) had signs or symptoms of COVID-19 (n=4) or were unable to be assessed due to decreased mental status (n=1). None of the nine underwent infectious disease consult, received specific therapy or died. Conclusion(s): Asymptomatic COVID-19 testing is of low yield in the pediatric ED when the daily community rate is less than 4 cases/100,000 individuals. Of those found to be positive under an asymptomatic testing protocol, over half had signs or symptoms attributed to COVID-19 infection suggesting the rate of asymptomatic infection was lower than reported. In the current pandemic, ED physicians should carefully assess for COVID-19 signs and symptoms even when children present for other indications.
Authors/Institutions: Evan Chua, University of California Davis School of Medicine, Sacramento, California, United States; James Ford, University of California Davis School of Medicine, Sacramento, California, United States; Charankyla K. Sandhu, University of California Davis School of Medicine, Sacramento, California, United States; Beth Morris, University of California Davis School of Medicine, Sacramento, California, United States; Larissa May, University of California Davis School of Medicine, Sacramento, California, United States; Stuart Cohen, University of California Davis School of Medicine, Sacramento, California, United States; James F. Holmes, University of California Davis School of Medicine, Sacramento, California, United States
