J Korean Med Sci.  2021 May;36(20):e148. 10.3346/jkms.2021.36.e148.

Characteristics in Pediatric Patients with Coronavirus Disease 2019 in Korea

• Seon JY
• Jeon WH
• Bae SC
• Eun BL
• Choung JT
• Oh IH

• KMID: 2516052
• DOI: http://doi.org/10.3346/jkms.2021.36.e148

Abstract

Background
Based on the reports of low prevalence and severity of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, the Korean government has released new SARS-CoV-2 infection response and treatment guidelines for children under the age of 12 years. The government has further directed school reopening under strict preventive measures. However, there is still considerable concern on the impact of school reopening on community transmission of Coronavirus disease 2019 (COVID-19). In the present study, we aimed to evaluate the appropriateness of these directives and the severity of SARS-CoV-2 infections in children as compared to adults using sufficient national sample data.
Methods
In the present study, we evaluated the severity of SARS-CoV-2 infection in pediatric patients as compared to adults by analyzing the length of hospital stays (LOS), medical expenses, and hospital and intensive care unit (ICU) admission rates. A multivariate linear regression analysis was carried out to examine the effects of COVID-19 patients that the characteristics on the LOS and medical expenses, and multivariate logistic regression analysis were performed to identify COVID-19 characteristics that affect hospital and ICU admission rates and to prove the low SARS-CoV-2 infection severity in pediatric patients.
Results
The hospitalization period for children aged 0–9 was 37% shorter and that of patients aged 10–19 years was 31% shorter than those of older age groups (P < 0.001). The analysis of the medical expenses by age showed that on average, medical expenses for children were approximately 4,900 USD lower for children than for patients over 80 years of age. The linear regression analysis also showed that patients who were 0–9 years old spent 87% and those aged 10–19 118% less on medical expenses than those aged 70 and over, even after the correction of other variables (P < 0.001). The probability of hospitalization was the lowest at 10–19 years old (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.03–0.09), and their ICU admission rate was also the lowest at 0.14 (OR, 0.14; 95% CI, 0.08–0.24). On the other hand, the likelihood of hospitalization and ICU admission was the highest in children aged 0–9 years, and among patients under the age of 50 years in general.
Conclusion
This study demonstrated the low severity of SARS-CoV-2 infection in younger patients (0–19 years) by analyzing the LOS, medical expenses, hospital, and intensive care unit admission rates as outcome variables. As the possibility to develop severe infection of coronavirus at the age of 10–19 was the lowest, a mitigation policy is also required for middle and high school students. In addition, children with underlying diseases need to be protected from high-risk infection environments.

Keyword

COVID-19 Pandemic; Pediatric Patient; Severity of Illness; Preventive Measures

Figure

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  Fig. 1 Flow chart for people inclusion and exclusion criteria, and the final sample size.We have had NHIS-COVID DB for 129,120 patients who were enrolled in the National health insurance service and have been treated in Hospital between January 1 and May 30, 2020. Among them, 8,070 were COVID-19 patients, and we selected finally 7,969 COVID-19 patients except for those with no record of medical expenses.COVID-19 = coronavirus disease 2019.

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