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Clinical Features and Temporal Changes of RT-PCR and Chest CT in COVID-19 Pediatric Patients: A Diagnostic Strategy Study
30 Pages Posted: 12 May 2020
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Clinical Features and Temporal Changes of RT-PCR and Chest CT in COVID-19 Pediatric Patients: A Diagnostic Strategy Study
Abstract
Background: To investigate the clinical features and temporal changes of RT-PCR and CT in COVID-19 pediatric patients, and explore the optimum diagnostic strategy.
Methods: One hundred and fourteen COVID-19 pediatric inpatients were retrospectively reviewed from January 21st to March 14th 2020. All patients had chest CT on admission and were identified as positive pharyngeal swab nucleic acid test. Clinical features were analyzed, as well as the features of RT-PCR and chest CT. The temporal changes of RT-PCR and chest CT were evaluated.
Findings: Fever (62, 54%) and cough (61, 54%) were the most common symptoms, while 20% of patients were asymptomatic. There were 34 (30%) cases of concurrent infections, of which mycoplasma (29, 25%) was the most common concurrent infection pathogen. The most common imaging features on chest CT were ground-glass opacities (46, 40%) and consolidation (46, 40%). The bilateral lower lobes were the most common pattern of involvement, with 63 cases (55%) involving 1-2 lobes, and in 32 (28%) cases CT was normal. Through the whole duration of COVID-19 in children, the diagnostic positive rate of RT-PCR has been far higher than that of CT (All P＜·05). For RT-PCR follow-up, reliable negative results were obtained only 7 days after the onset of symptoms. Chest CT changes peaked on days 11-15, with an average of 1·5 lobes involved.
Interpretation: RT-PCR is more reliable than CT in initial diagnosis of pediatric patients with COVID-19. On follow up, reliable RT-PCR results are not available until at least 7 days after initial symptoms. CT sensitivity is low initially and plateaus at 11-15 days.
Funding Statement: National Natural Science Foundation of China, Hubei Province health and family planning scientific research project, HUST Innovation Project 2020, and Wuhan children’s hospital Foundation.
Declaration of Interests: The authors of this manuscript declare that there is no conflict of interest regarding the publication of this paper.
Ethics Approval Statement: The local institutional review board approved this retrospective study, and informed consent was waived.
Keywords: Child; COVID-19; infection; clinical features; tomography
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