The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
Severe COVID-19 outcomes in pediatrics: an observational cohort analysis comparing Alpha, Delta, and Omicron variants
Open accessAbstract
Objective: COVID-19 can rarely lead to severe illness in pediatric patients. The aim of this study was to determine if severe outcomes in pediatric COVID-19 have changed over the course of the pandemic. Methods: This was a multicenter, observational cohort analysis from a large regional healthcare system in metro Detroit using electronic health record data to evaluate emergency visits, hospitalization, and severe COVID-19 disease in pediatric patients. Consecutive pediatric patients presenting to the emergency department with a primary diagnosis of COVID-19 were included. Outcomes data was gathered from three distinct time intervals that coincided with Alpha, Delta, and Omicron variant predominance (Time interval 1 (T1) 1/1/2021-6/30/2021: Alpha, T2 7/1/2021-12/31/2021: Delta, T3 1/1/2022-6/16/2022): Omicron. The primary outcome was severe disease inclusive of composite intensive care unit admission, mechanical ventilation, multisystem inflammatory syndrome in children (MIS-C), myocarditis, or death. Secondary outcomes included severe outcomes considering viral coinfection and vaccination status. Results: Between 1/1/2021 and 6/16/2022, there were 4517 emergency COVID-19 visits, of which 12.5% (566) of children were hospitalized. 24.4% (138), 31.6% (179), and 44.0% (249) of admissions occurred during T1, T2 and T3 respectively. Most patients were male (55.1%) and 59.9% identified as Caucasian. The median age was 5.0 (interquartile range 1.0, 13.0) with infants comprising 22.8% (129), toddlers 25.1% (142), children 23.0% (130), and teenagers 29.2% (165). Over the course of the pandemic, the proportion of infants in hospitalization increased from 16.7% in T1 to 19.6% in T2 to 28.5% in T3 (p < 0.01) while the proportion of teenagers in hospitalization decreased from 39.1% in T1 to 31.3% in T2 to 22.1% in T3 (p < 0.001). Oxygen therapy was required in a minority (29.9%) of cases with supplemental oxygen utilized the least in T3 (16.5%) and most in T2 (30.2%). Composite severe disease decreased throughout the pandemic occurring in 36.2% in T1, 27.4% in T2, and 18.9% in T3. A multivariable logistic regression analysis revealed the odds of composite severe disease was significantly lower in T3 compared to T1 (adjusted odds ratio [aOR] 0.35, 95% Confidence Interval 0.21-0.60, p < 0.001). Fully vaccinated or fully vaccinated and boosted admission rates remained low throughout all periods with 4.4% in T1, 4.5% in T2 and 8.4% in T3. Viral coinfection was most common during T2 (16.8%) followed by T3 (12.5%) and least common in T1 (5.1%) (p = 0.006). Coinfection occurred more commonly in younger children with a median age of 1.2 (0.0, 4.5) compared to those with mono-infection with a median age of 6 (1.0, 14.0) (p < 0.001). Severe outcomes occurred in 45.6% of coinfection cases compared to 22.1% without coinfection (p < 0.001). Conclusions: While Omicron cases had the highest admission frequency, severe illness was lower than Delta and Alpha variants. Coinfection with respiratory viruses increased the risk of severe outcomes and impacted infants more than older children. Funding: None.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Omicron had the highest admission frequency for poor outcome including death, but severe illness was lower than with Delta and Alpha variants.
“A recent pediatric study reported that Omicron had the highest admission frequency for poor outcome including death, but severe illness was lower than with Delta and Alpha variants. 101”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [101]
The Abstract Results report that the Omicron-predominant period had the largest share of pediatric admissions (44.0%) but the lowest rate of composite severe disease (18.9%, versus 27.4% for Delta and 36.2% for Alpha). The Methods include death in that composite. The paper does not say Omicron had the highest admission frequency for poor outcomes specifically, including death; that qualification conflates overall admissions with severe outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOmicron cases had greater infectivity and the highest hospital admission frequency, but severe illness was lower than Delta and Alpha variants.
“Omicron cases had greater infectivity and the highest hospital admission frequency, but severe illness was lower than Delta and Alpha variants.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [101]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Feudtner, C., Feinstein, J. A., Zhong, W., Hall, M., & Dai, D. (2014) · BMC Pediatrics · doi:10.1186/1471-2431-14-199 · Cited by 1,770
COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study
Götzinger, F., Santiago, B., Noguera‐Julián, A., Lanaspa, M., Lancella, L., Carducci, F. I. C., Gabrovska, N., Velizarova, S. A., Prunk, P., Osterman, V., et al. (2020) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(20)30177-2 · Cited by 1,221
SARS-CoV-2 Omicron variant replication in human bronchus and lung ex vivo
Hui, K. P. Y., Ho, J. C. W., Cheung, M.-C., Ng, K., Ching, R. H. H., Lai, K.-L., Kam, T. T., Gu, H., Sit, K., Hsin, M. K. Y., et al. (2022) · Nature · doi:10.1038/s41586-022-04479-6 · Cited by 840
SARS-COV-2 infection in children and newborns: a systematic review
Liguoro, I., Pilotto, C., Bonanni, M., Ferrari, M. E., Pusiol, A., Nocerino, A., Vidal, E., & Cogo, P. E. (2020) · European Journal of Pediatrics · doi:10.1007/s00431-020-03684-7 · Cited by 562
Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children
Kompaniyets, L., Agathis, N. T., Nelson, J. M., Preston, L. E., Ko, J. Y., Belay, B., Pennington, A. F., Danielson, M. L., DeSisto, C. L., Chevinsky, J., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.11182 · Cited by 402
SARS-CoV-2 co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses
Swets, M. C., Russell, C. D., Harrison, E. M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00383-x · Cited by 335
Virological and Immunological Outcomes of Coinfections
Kumar, N., Sharma, S., Barua, S., Tripathi, B. N., & Rouse, B. T. (2018) · Clinical Microbiology Reviews · doi:10.1128/cmr.00111-17 · Cited by 236
Bailey, L. C., Razzaghi, H., Burrows, E. K., Bunnell, H. T., Camacho, P., Christakis, D., Eckrich, D., Kitzmiller, M., Lin, S. M., Magnusen, B., et al. (2020) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2020.5052 · Cited by 226
Omicron: increased transmissibility and decreased pathogenicity
Bálint, G., Vörös-Horváth, B., & Széchenyi, A. (2022) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-022-01009-8 · Cited by 182
Reese, H. E., Iuliano, A. D., Patel, N. N., Garg, S., Kim, L., Silk, B. J., Hall, A. J., Fry, A. M., & Reed, C. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1780 · Cited by 181
Scotta, M. C., Chakr, V. C. B. G., de Moura, A., Becker, R., de Souza, A. P. D., Jones, M. H., Pinto, L. A., Sarria, E. E., Pitrez, P. M., Stein, R. T., et al. (2016) · Journal of Clinical Virology · doi:10.1016/j.jcv.2016.04.019 · Cited by 176
Martin, B., DeWitt, P. E., Russell, S., Anand, A., Bradwell, K. R., Bremer, C., Gabriel, D. L., Girvin, A. T., Hajagos, J., McMurry, J. A., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.43151 · Cited by 172
Wang, L., Berger, N. A., Kaelber, D. C., Davis, P. B., Volkow, N. D., & Xu, R. (2022) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2022.0945 · Cited by 150
Voiriot, G., Visseaux, B., Cohen, J., Nguyen, L. B. L., Neuville, M., Morbieu, C., Burdet, C., Radjou, A., Lescure, F.-X., Smonig, R., et al. (2016) · Critical Care · doi:10.1186/s13054-016-1517-9 · Cited by 150
Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients
Liu, Y., Ling, L., Wong, S. H., Wang, M. H., Fitzgerald, J. R., Zou, X., Fang, S., Liu, X., Wang, X., Hu, W., et al. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.100955 · Cited by 133
Bahl, A., Johnson, S., Maine, G. N., Garcia, M. H., Nimmagadda, S., Qu, L., & Chen, N. (2021) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2021.100065 · Cited by 115
Self-citationSystematic review and meta‐analysis of respiratory viral coinfections in children
Lim, F. J., de Klerk, N. H., Blyth, C. C., Fathima, P., & Moore, H. C. (2016) · Respirology · doi:10.1111/resp.12741 · Cited by 91
Respiratory syncytial virus: co-infection and paediatric lower respiratory tract infections
Yoshida, L., Suzuki, M., Nguyen, H. A. T., Le, M. N., Thiểm, V. Đ., Yoshino, H., Schmidt, W., Nguyen, T. T. A., Le, H. T., Morimoto, K., et al. (2013) · European Respiratory Journal · doi:10.1183/09031936.00101812 · Cited by 82
George, J. A., AlShamsi, S. H., Alhammadi, M. H., et al. (2021) · Viruses · doi:10.3390/v13081630 · Cited by 33
Narayanan, R. P., Nordlund, J., Pace, R. K., & Ratnadiwakara, D. (2020) · PLoS ONE · doi:10.1371/journal.pone.0239572 · Cited by 22
Boosters reduce in-hospital mortality in patients with COVID-19: An observational cohort analysis
Mielke, N., Johnson, S., & Bahl, A. (2022) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2022.100227 · Cited by 18
Self-citationJohnson, S., Mielke, N., Mathew, T. A., et al. (2022) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.12793 · Cited by 11
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- Forrest, 2022, Severity of acute COVID-19 in children <18 years old March 2020 to December 2021, Pediatrics, 149, 10.1542/peds.2021-055765 · DOI
Cited by
Sorted by citations
COVID-19, Myocarditis and Pericarditis
Fairweather, D., Beetler, D. J., Di Florio, D. N., Musigk, N., Heidecker, B., & Cooper, L. T. (2023) · Circulation Research · doi:10.1161/circresaha.123.321878 · Cited by 194
Metadata
- Authors
- Bahl, A., Mielke, N., Johnson, S., Desai, A., & Qu, L.
- Affiliations
- Beaumont Health (US)
- Oakland University (US)
- University Hospitals of Cleveland (US)
- Corresponding author
- Bahl, Amit
- Venue
- The Lancet Regional Health - Americas
- Publisher
- Elsevier BV
- Published
- 2023-02
- Volume
- 18
- Pages
- 100405
- ISSN
- 2667-193X (ISSN-L)
- PMC
- PMC9714340
- OpenAlex
- W4310957136
- Cited by
- 76
- References
- 22
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 26 · 2023: 33
- FWCI
- 8.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Regional Health - Americas (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- pediatric COVID-19, SARS-CoV-2 variants, Alpha variant, Delta variant, Omicron variant, severe COVID-19 outcomes, hospitalization, intensive care unit admission, mechanical ventilation, multisystem inflammatory syndrome in children, myocarditis, viral coinfection, COVID-19 vaccination, infants, adolescents, emergency department visits, Detroit metropolitan area, 2021-2022 pandemic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
