Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review

Julian Hirt; Perrine Janiaud; Viktoria Luise Gloy; Stefan Schandelmaier; Tiago V Pereira; Despina Contopoulos-Ioannidis; Steven N Goodman; John Ioannidis; Klaus Munkholm; Lars G Hemkens

doi:10.1136/archdischild-2022-324455

Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review

Arch Dis Child. 2023 Jun;108(6):498-505. doi: 10.1136/archdischild-2022-324455. Epub 2022 Sep 2.

Authors

Julian Hirt^{1

2}, Perrine Janiaud¹, Viktoria Luise Gloy¹, Stefan Schandelmaier^{1

3}, Tiago V Pereira^{4

5}, Despina Contopoulos-Ioannidis⁶, Steven N Goodman^{7

8

9}, John Ioannidis^{7

8

9

10

11}, Klaus Munkholm^{12

13}, Lars G Hemkens^{14

9

11}

Affiliations

¹ Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
² International Graduate Academy, Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
³ Department of Clinical Epidemiology and Biostatistics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
⁴ Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
⁵ Department of Health Sciences, College of Medicine, University of Leicester, Leicester, UK.
⁶ Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
⁷ Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.
⁸ Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
⁹ Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA.
¹⁰ Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, USA.
¹¹ Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
¹² Department of Clinical Research, Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark.
¹³ Open Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark.
¹⁴ Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland Lars.Hemkens@usb.ch.

Abstract

Objective: To systematically assess the robustness of reported postacute SARS-CoV-2 infection health outcomes in children.

Methods: A search on PubMed and Web of Science was conducted to identify studies published up to 22 January 2022 that reported on postacute SARS-CoV-2 infection health outcomes in children (<18 years) with follow-up of ≥2 months since detection of infection or ≥1 month since recovery from acute illness. We assessed the consideration of confounding bias and causality, as well as the risk of bias.

Results: 21 studies including 81 896 children reported up to 97 symptoms with follow-up periods of 2.0-11.5 months. Fifteen studies had no control group. The reported proportion of children with post-COVID syndrome was between 0% and 66.5% in children with SARS-CoV-2 infection (n=16 986) and between 2.0% and 53.3% in children without SARS-CoV-2 infection (n=64 910). Only two studies made a clear causal interpretation of an association between SARS-CoV-2 infection and the main outcome of 'post-COVID syndrome' and provided recommendations regarding prevention measures. The robustness of all 21 studies was seriously limited due to an overall critical risk of bias.

Conclusions: The robustness of reported postacute SARS-CoV-2 infection health outcomes in children is seriously limited, at least in all the published articles we could identify. None of the studies provided evidence with reasonable certainty on whether SARS-CoV-2 infection has an impact on postacute health outcomes, let alone to what extent. Children and their families urgently need much more reliable and methodologically robust evidence to address their concerns and improve care.

Keywords: COVID-19; infectious disease medicine.

Publication types

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

MeSH terms

Bias
COVID-19* / epidemiology
COVID-19* / prevention & control
Child
Humans
Outcome Assessment, Health Care
SARS-CoV-2