Pediatr Emerg Med J.  2022 Dec;9(2):90-94. 10.22470/pemj.2022.00528.

Clinical features of croups caused by severe acute respiratory syndrome coronavirus 2 and by other respiratory viruses: analysis in a tertiary hospital in Jinju, Korea during the period of dominance of the Omicron variant (B.1.1.529)

• Park SH
• Jeong JH
• Park JJ
• Seo JH

• KMID: 2538069
• DOI: http://doi.org/10.22470/pemj.2022.00528

Abstract

Purpose
Croup is a clinical manifestation of coronavirus disease 2019 (COVID-19) in children. The Omicron variant of severe acute respiratory syndrome coronavirus 2 usually causes an upper respiratory tract infection. We investigated the differences between croups caused by COVID-19 and by other respiratory viruses (ORV).
Methods
We reviewed clinical characteristics, therapeutic measures, and the Westley Croup Score of children with croup who visited the emergency department of Gyeongsang National University Hospital from January 1 through April 7, 2022. According to the laboratory-confirmed viruses, they were divided into 2 groups: COVID-19 and ORV. Between the 2 groups, we compared the abovementioned features. Moderate-to-severe croup was defined by a Westley Croup Score of 3 or higher.
Results
A total of 20 children were diagnosed with croup caused by COVID-19 (n = 11; median age, 18 months) or by ORV (n = 9; 7 months). Median Westley Croup Score was higher in the COVID-19 group than in the ORV group (5.0 [range, 0-10.0] vs. 2.0 [1.0-5.0]; P = 0.031). Among the components of the scoring system, only stridor showed a significant difference (e.g., “stridor at rest”: COVID-19, 8 of 11 vs. ORV, 2 of 9; P = 0.046). Median C-reactive protein concentration was higher in the COVID-19 group (3.2 vs. 0.4 mg/L; P = 0.007). Severity of the COVID-19 group was marginally higher than that of the ORV group in terms of the median oxygen saturation (95% vs. 98%; P = 0.056) and the proportions of moderate-to-severe croup (9 of 11 vs. 3 of 9; P = 0.065) and application of high-flow nasal cannula (4 of 11 vs. 0 of 9; P = 0.094).
Conclusion
Croup caused by COVID-19 during the period of dominance of the Omicron variant outbreak might be more severe than croup caused by ORV.

Keyword

Child; COVID-19; Croup; Severity of Illness Index; Therapeutics

Reference

References

1. Crisis Communication Team, Central Quarantine Countermeasure Headquarters. Characterization of Omicron variation and diffusion contrast (regular briefing on January 24) [Internet]. Sejong (Korea): Ministry of Health and Welfare;c2022 [cited 2022 Jan 24]. Available from: https://ncov.kdca.go.kr/tcmBoardView.do?brdId=3&brdGubun=31&dataGubun=&ncvContSeq=6313&contSeq=6313&board_id=312&gubun=ALL. Korean.

2. Crisis Communication Team, Central Quarantine Countermeasure Headquarters. Establishment of quarantine and home treatment system considering the characteristics of Omicron [Internet]. Sejong (Korea): Ministry of Health and Welfare;c2022 [cited 2022 Feb 7]. Available from: https://ncov.kdca.go.kr/tcmBoardView.do?brdId=&brdGubun=&dataGubun=&ncvContSeq=370082&contSeq=370082&board_id=&gubun=ALL. Korean.

3. Brewster RC, Parsons C, Laird-Gion J, Hilker S, Irwin M, Sommerschield A, et al. COVID-19-associated croup in children. Pediatrics. 2022; 149:e2022056492.

4. Tunҫ EM, Koid Jia Shin C, Usoro E, Thomas-Smith SE, Trehan I, Migita RT, et al. Croup during the coronavirus disease 2019 Omicron variant surge. J Pediatr. 2022; 247:147–9.

5. Jinju City Council. Regarding the prevention of the spread of COVID-19 and measures to be taken: Daily Briefing Materials (725th) [Internet]. Jinju (Korea): Jinju City Council;c2022 [cited 2022 Feb 9 ]. Available from: https://www.jinju.go.kr/00130/02730/06679.web?gcode=4192&idx=39506204&amode=view&cpage=1&sstring=725&stype=title. Korean.

6. Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, et al. Part 4: Pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142(16 Suppl 2):S469–523.

7. Russell KF, Liang Y, OʼGorman K, Johnson DW, Klassen TP. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011; (1):CD001955.

8. Jeon IS, Cho WJ, Lee J, Kim HM. Epdiemiology and clinical severity of the hospitalized children with viral croup. Pediatr Infect Vaccine. 2018; 25:8–16. Korean.

9. Lee DR, Lee CH, Won YK, Suh DI, Roh EJ, Lee MH, et al. Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 emergency departments in Korea. Korean J Pediatr. 2015; 58:380–5.