Differences in Clinical and Imaging Presentation of Pediatric Patients with COVID-19 in Comparison with Adults

Chen, Amei; Huang, Junxiang; Liao, Yuting; Liu, Zaosong; Chen, Dandan; Yang, Chongzhe; Yang, Ruimeng; Wei, Xinhua

BACKGROUND: Although Coronavirus Disease 2019 (COVID-19) affects patients from all age groups, clinical and radiological features of COVID- 19 have been mainly described in adults. OBJECTIVE: To characterize and compare the initial clinical and imaging features of COVID-19 in pediatric and adult patients undergoing chest computed tomography (CT). MATERIALS AND METHODS: A total of 61 patients, consisting of 47 adults (18 years old or older) and 14 pediatric patients (younger than 18 years old) with laboratory-confirmed COVID-19 by real-time reverse transcriptase polymerase chain reaction (RT-PCR) between January 25, 2020 and February 15, 2020 were enrolled in this study. All patients underwent chest CT within 3 days after the initial RT-PCR. The clinical presentation, serum markers, and CT findings were assessed and compared between the adult and pediatric patients. RESULTS: Fever was less common in pediatric patients than in adults (6/14, 42.9% vs 39/47, 83%; p = 0.008). Leukopenia or normal, lymphopenia or normal, and increased or normal C-reactive protein were common in both groups with no difference (p > 0.05). Compared with the adults, pediatric patients had a lower rate of positive CT findings and a milder clinical grade (p = 0.004, p = 0.001 respectively). On chest CT, the number of pulmonary lobes involved was reduced in pediatric patients when compared to adults (p = 0.012). Subpleural distribution of lung opacities was a dominant feature in both groups, whereas bronchial distribution was more common in the pediatric group (p = 0.048). Among the CT features in adults, ground-glass opacities (GGO) were the most common finding (24/43, 53.5%), followed by GGO with consolidation (14/43, 27.9%). In pediatric patients, GGOs accounted for 42.9% (3/7), bronchial wall thickening occurred in 28.6% (2/7), and GGOs with consolidations and nodular opacities in 14.3% (1/7). However, these CT features did not differ in two groups, except for bronchial wall thickening, which was more commonly found in pediatric patients (p=0.048). Additionally, the semi-quantitative scores of lung involvement were higher in adults than in pediatric patients (8.89 ± 4.54 vs 1.86 ± 2.41, p < 0.001). CONCLUSIONS: Compared to adults, pediatric patients with COVID-19 showed distinctive clinical and CT. Pediatric patients tend to have milder clinical symptoms, fewer positive CTs, and less extensive involvement on imaging. Bronchial wall thickening was relatively more frequent on CT images from pediatric patients with COVID-19 in comparison with adults.