Clinical characteristics of COVID-19 in children and adolescents: a systematic review and meta-analysis

Lou, L.; Zhang, H.; Tang, B.; Li, M.; Li, Z.; Cao, H.; Li, J.; Chong, Y.

Background: Although the number of COVID-19 (coronavirus disease 2019) cases continues to increase globally, there are few studies on the clinical characteristics of children and adolescents with COVID-19. Objective: To conduct a comprehensive systematic evaluation and meta-analysis of the clinical characteristics of COVID-19 in children and adolescents to better guide the response to the current epidemic. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI (Chinese database), Clinical Trials.gov and chictr.org.cn (China). The methodological quality of the included literature was evaluated using the Quality Assessment Tool for Case Series Studies. Meta-analysis was performed using STATA 14.0. Heterogeneity was assessed by the Q statistic and quantified using I2. We used fixed-effects or random-effects models to pool clinical data in the meta-analysis. Publication bias was evaluated by the Begg's test. Results: We analyzed 49 studies involving 1627 patients. In the pooled data, the most common clinical symptoms were fever (56% [0.50-0.61]) and cough (45% [0.39-0.51]). The most common laboratory abnormalities were elevated procalcitonin (40% [0.23-0.57]), elevated lactate dehydrogenase (31% [0.19-0.43]), increased lymphocyte count (28% [0.17-0.42]), increased creatine kinase (28% [0.18- 0.40]), and elevated C-reactive protein (26% [0.17-0.36]). The most common abnormalities determined by computed tomography were lower-lobe involvement (56% [0.42- 0.70]), ground-glass opacities (33% [0.25-0.42]), bilateral pneumonia (32% [0.24- 0.40]), patchy shadowing (31% [0.18- 0.45]), and upper lobe involvement (30% [0.20- 0.41]). Conclusion: Disease severity among children and adolescents with COVID-19 was milder than that among adult patients, with a greater proportion of mild and asymptomatic cases, and thus, the diagnosis of COVID-19 and control of the infection source are more challenging.