The 2019 coronavirus disease has not appeared to affect children as severely as adults. However, approximately 1 month after the COVID-19 peak in New York City in April 2020, cases of children with prolonged fevers abruptly developing inflammatory shock-like states have been reported in Western Europe and the United States. This case series describes four previously healthy children with COVID-19 infection confirmed by serologic antibody testing, but negative by nasopharyngeal RT-PCR swab, presenting to the Pediatric Emergency Department (PED) with prolonged fever (5 or more days) and abrupt onset of hemodynamic instability with elevated serologic inflammatory markers and cytokine levels (IL-6, IL-8 and TNF-α). Emergency physicians must maintain a high clinical suspicion for this COVID-19 associated post-infectious cytokine release syndrome, with features that overlap with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS) in children with recent or current COVID-19 infection, as patients can decompensate quickly.

To the EditorAn increasing number of analyses use administrative claims data to study the epidemiology, risk factors, and resource consumption associated with patients with ocular diseases. These sources of voluminous data allow researchers to study common and uncommon conditions and assess care delivered by different providers in various communities. Since claims data are collected primarily for billing, not research purposes, a concern is whether the diagnoses listed in the billing records reflect the actual conditions described in the medical record. 1 If claims data were found to inaccurately reflect patients' conditions, the usefulness of these data for research would be limited. The accuracy of claims data has been examined for selected eye diseases but not for many common ophthalmic conditions. [2][3][4] We examine the accuracy of claims data for five such conditions. MethodsWith Institutional Review Board approval, 982 consecutive billing records of patients coded with the following ocular conditions were identified from two academic medical centers: cataract (International Classification of Disease-9 [ICD-9-CM] codes 366-366.4), glaucoma suspect (365.0), primary open angle glaucoma (OAG) (365.11), proliferative diabetic retinopathy (PDR) (362.02), and nonexudative macular degeneration (NEAMD) (362.51). One abstractor (KWM) reviewed the documentation in the medical record for each billed encounter and scored the billing code as correct or incorrect. An encounter was classified as billed correctly if evidence in the medical record substantiated that the patient had the condition indicated on the billing form. If no such confirmatory evidence was found, the encounter was classified as billed incorrectly. ResultsOf the 982 encounters reviewed, 949 (97%) were coded correctly. The proportion of encounters with correct codes ranged from 92% (NEAMD) to 100% (cataract) (Table 1).