56 Factors Predicting Admission in Pediatric and Young Adults With COVID-19

Dhillon, R. S.; Weise, M.; Wrotniak, B.; Cross, K.

Study Objectives: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and COVID-19- its associated disease in humans- appears to cause more severe morbidity and mortality in older adults and geriatric patients than in children and young adults. There is growing recognition of the association between both race and obesity and disease severity in hospitalized patients with COVID-19.However, the impact of age, race, and other major comorbidities on COVID-19 course in children and younger adults is not as well understood. Methods: We conducted a retrospective analysis of 2656 patients under the age of 36 years with COVID-19 between March 1, 2020 and August 6, 2020 as reported to HEALTHeLINK, a regional health information system for western New York State. Subjects were split into pediatric (0-19 years) and young adult (20- 36 years) datasets. We evaluated the association between candidate risk factors (age, sex, race, calculated BMI/BMI percentile, smoking status, diabetes, pre-existing respiratory disease, hypertension, and sickle cell disease) using recursive partitioning and linear regression. The primary outcome was hospital admission, with length of stay being the secondary outcome Results: There were 2129 young adults and 527 pediatric patients who tested positive for COVID-19 during our study period. In our young adult population, race was the most significant predictor of admission, followed by BMI. African Americans with a BMI > 23 had the highest rate of admission (66%, p<0.001). Interestingly, Asian race was a strong predictor of outpatient management, regardless of BMI. Smoking status and hypertension were less significant predictors of admission, whereas sex, diabetes, preexisting respiratory conditions, and sickle cell disease were not significant. For our pediatric population, race was also the most significant predictor of admission, with African Americans being admitted at higher rates than Whites and Asians. In the pediatric population, however, BMI percentile for age was not a predictor of admission. In regards to the secondary outcome, admitted young adult with COVID-19 had an average length of stay of 1.4 days (SD ±2) while the admitted pediatric COVID-19 patients had an average length of stay of 1 day (SD ±1.1). African American race was associated with longer length of stay in both populations however, BMI was only significant in the young adult population. Conclusions: In a regional population of young adult and pediatric patients with COVID-19, race was strongly predictive of admission and length of stay. African American patients were most likely to be admitted, while Asian race was a strong predictor of outpatient management. For African American young adults, a BMI > 23 was the strongest additional predictor of admission. For younger patients with COVID-19 a simple decision tree that incorporates age, race, and BMI can help identify those patients least likely to need inpatient management. [Formula presented]