Comparing Chinese children and adults with RT-PCR positive COVID-19: A systematic review

Abstract

Background The various clinical manifestations of COVID-19 with RT-PCR positive patients have been reported. However, the differences in the clinical presentation between children and adults were unclear. Thus, we aimed to investigate the differences in the clinical manifestations and imaging characteristics between Chinese children and adults with COVID-19 by systematically analyzing the data derived from some latest literatures. Methods An extensive search of COVID-19 papers was conducted in PubMed and Chinese medical journal network, and relevant articles were selected based on some standard requirements. The included papers were analyzed for differences in clinical manifestation between children and adults with COVID-19 after the quality evaluation with the QUADAS-2 tool. The differences in the clinical features and CT findings were analyzed using a Pearson χ 2 test or Fisher's exact test. Patients who underwent CT examination were divided into the initial examination (0–4days) and follow-up examination groups (5–14 days). Results A total of 345patients (70 children and 275 adults) with RT- PCR (+) were included in our study (5 papers for children and 5 papers for adult groups). Significant differences between children and adults were found in exposure history (p < 0.001, χ 2 = 166.890), fever (p = 0.016, χ 2 = 5.757), white cell count (p < 0.001, χ 2 = 14.043), and CT features in the initial (p < 0.001, χ 2 = 60.653) and follow-up stages (p < 0.001, χ 2 = 52.924); and the involved lung in the follow-up stage (p ＜ 0.001, χ 2 = 16.776). Conclusions Some differences have been presented between children and adults with RT-PCR positive COVID-19, which are helpful in the management and protection of children with COVID-19.

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

“…The great majority of studies included in all reviews were from China, with studies also from Italy, Spain, South Korea, Malaysia, Singapore, Vietnam, Iran and the USA. Eight were high quality, 11 14 15 17 19 24 27 28 7 were medium, 16 18 20-23 26 and 3 were low quality. 12 13 25 The very great majority of studies within the reviews were of hospitalised CYP.…”

“…No reviews specifically focused on symptoms or signs amongst community samples of infected children, and none compared symptoms in hospitalised compared with non-hospitalised children. One review included only studies of infants 16 , one included a comparison of symptoms in children with those in adults from China, 26 and one examined only gastrointestinal symptoms. 28 One study provided descriptive data from included studies only and did not report pooled estimates of symptom prevalence.…”

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

“…We included 18 reviews in our analysis. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Characteristics of the included reviews are shown in table 1; all are freely available online (see online supplemental appendix table 2). All reviews were in English.…”

“…No reviews specifically focused on symptoms or signs among community samples of infected children, and none compared symptoms in hospitalised compared with non-hospitalised children. One review included only studies of infants, 16 one included a comparison of symptoms in children with those in adults from China 26 and one examined only gastrointestinal symptoms. 28 One study provided descriptive data from included studies only and did not report pooled estimates of symptom prevalence.…”

“…Only one review compared CYP with adults. Pei et al 26 undertook a medium-quality review comparing symptoms in 170 children and 275 adults, restricting the analysis to studies from China. They reported that CYP were more likely to be asymptomatic than adults (20% compared with 5.5%).…”