Corticosteroids and Other Treatments Administered to Children Tested for SARS-CoV-2 Infection in Emergency Departments

Stephen B Freedman; Nathan Kuppermann; Anna L Funk; Kelly Kim; Jianling Xie; Daniel Tancredi; Stuart R Dalziel; Mark I Neuman; Santiago Mintegi; Amy C Plint; Jessica Gómez-Vargas; Yaron Finkelstein; Lilliam Ambroggio; Terry P Klassen; Marina Salvadori; Richard Malley; Daniel C Payne; Todd A Florin; Pediatric Emergency Research Network-COVID-19 Study Team

doi:10.1016/j.acap.2022.04.006

Corticosteroids and Other Treatments Administered to Children Tested for SARS-CoV-2 Infection in Emergency Departments

Acad Pediatr. 2022 Sep-Oct;22(7):1200-1211. doi: 10.1016/j.acap.2022.04.006. Epub 2022 Apr 22.

Authors

Stephen B Freedman¹, Nathan Kuppermann², Anna L Funk³, Kelly Kim³, Jianling Xie³, Daniel Tancredi⁴, Stuart R Dalziel⁵, Mark I Neuman⁶, Santiago Mintegi⁷, Amy C Plint⁸, Jessica Gómez-Vargas⁹, Yaron Finkelstein¹⁰, Lilliam Ambroggio¹¹, Terry P Klassen¹², Marina Salvadori¹³, Richard Malley¹⁴, Daniel C Payne¹⁵, Todd A Florin¹⁶; Pediatric Emergency Research Network-COVID-19 Study Team

Affiliations

¹ Divisions of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine (SB Freedman), University of Calgary, Calgary, Canada. Electronic address: Stephen.freedman@ahs.ca.
² Departments of Emergency Medicine and Pediatrics (N Kuppermann), University of California (UC), Davis School of Medicine, and UC Davis Health, Sacramento, Calif.
³ Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine (AL Funk, K Kim, and J Xie), University of Calgary, Calgary, Canada.
⁴ Department of Pediatrics (D Tancredi), UC Davis School of Medicine, Sacramento, Calif.
⁵ Departments of Surgery and Paediatrics, Child and Youth Health, The University of Auckland and Children's Emergency Department (SR Dalziel), Starship Children's Hospital, Auckland, New Zealand.
⁶ Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics (MI Neuman), Harvard Medical School, Boston, Mass.
⁷ Pediatric Emergency Department (S Mintegi), Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Spain.
⁸ Departments of Pediatrics and Emergency Medicine (AC Plint), University of Ottawa and Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Canada.
⁹ Emergency Department (J Gómez-Vargas), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, CCSS, San José, Costa Rica.
¹⁰ Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics (Y Finkelstein), Hospital for Sick Children, Toronto, Canada.
¹¹ Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics (L Ambroggio), University of Colorado, Denver, Colo.
¹² Children's Hospital Research Institute of Manitoba and Department of Pediatrics and Child Health (TP Klassen), University of Manitoba, Winnipeg, Canada.
¹³ Public Health Agency of Canada, Division of Infectious Diseases, Department of Pediatrics McGill University (M Salvadori), Montreal, Canada.
¹⁴ Division of Infectious Diseases (R Malley), Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Mass.
¹⁵ Centers for Disease Control and Prevention (DC Payne), Atlanta, United States.
¹⁶ Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics (TA Florin), Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: taflorin@luriechildrens.org.

Abstract

Objective: We sought to determine if corticosteroid administration is associated with a SARS-CoV-2 nucleic acid test-positive result and to describe therapies administered to SARS-CoV-2 infected children.

Methods: We collected cross-sectional data from participants recruited in 41 pediatric emergency departments (ED) in 10 countries between March 2020 and June 2021. Participants were <18 years old, had signs or symptoms of, or risk factors for acute SARS-CoV-2 infection, and had nucleic acid testing performed. To determine if SARS-CoV-2 test status was independently associated with corticosteroid administration, we used a multivariable conditional logistic regression model matched by study site to compare treatments administered based on SARS-CoV-2 test and disposition status. This analysis was repeated for the subgroup of study participants who were hospitalized.

Results: 30.3% (3,121/10,315) of participants were SARS-CoV-2-positive. Although remdesivir was more commonly administered to SARS-CoV-2-positive children, use was infrequent (25/3120 [0.8%] vs 1/7188 [0.01%]; P = .001). Corticosteroid use was less common among SARS-CoV-2-positive children (219/3120 [7.0%] vs 759/7190 [10.6%]; P < .001). Among hospitalized children, there were no differences in provision of inotropes, respiratory support, chest drainage or extracorporeal membrane oxygenation between groups. Corticosteroid administration was associated with age, history of asthma, wheezing, study month, hospitalization and intensive care unit admission; it was not associated with a positive SARS-CoV-2 test result overall (aOR: 0.91; 95%CI: 0.74, 1.12) or among the subgroup of those hospitalized (aOR: 1.04; 95%CI: 0.75, 1.44).

Conclusions: Few disease-specific treatments are provided to SARS-CoV-2-positive children; clinical trials evaluating therapies in children are urgently needed.

Keywords: COVID-19; SARS-CoV-2; adrenal cortex hormones; child, hospitalized; emergency service, hospital.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adrenal Cortex Hormones / therapeutic use
COVID-19 Drug Treatment*
Child
Cross-Sectional Studies
Emergency Service, Hospital
Humans
Nucleic Acids*
SARS-CoV-2

Substances

Adrenal Cortex Hormones
Nucleic Acids

Abstract

Publication types

MeSH terms

Substances

Grants and funding