Diagnostic Value of Symptoms for Pediatric SARS-CoV-2 Infection in a Primary Care Setting

Weng, C.-H.; Butt, W. W. W.; Brooks, M. B.; Clarke, C.; Jenkins, H.; Holland, S. D.; Chiang, S. S.

Purpose To evaluate the diagnostic value of symptoms used in the screening approaches by daycares and schools for identifying children and adolescents with possible SARS-CoV-2 infection, we designed a large observational study utilizing the data from primary care settings. Methods This cohort study included children and adolescents evaluated in a network of clinics in Rhode Island. Participants were age-stratified: 0-4, 5-11, and 12-17 years. We estimated the sensitivity, specificity, and area under the receiver operating curve (AUC) of individual symptoms and three symptom combinations: a probable case definition published by the Rhode Island Department of Health (RIDOH), and two novel combinations generated by different statistical approaches to maximize sensitivity and AUC. We evaluated the test characteristics of symptom combinations both with and without consideration of COVID-19 exposure. Results Two-hundred seventeen (39.1%) of 555 participants were SARS-CoV-2-infected. Fever was more common among 0-4 years-olds (p=0.002); older children more frequently reported fatigue (p=0.02) and anosmia or ageusia (p=0.047). In children >5 years old, anosmia or ageusia had 94-98% specificity. In all age groups, exposure history most accurately predicted infection. In combination with COVID-19 exposure history, various symptom combinations had sensitivity >95% but specificity <30%. No individual symptom or symptom combination had AUC [≥]0.70. Conclusions Anosmia or ageusia in children [≥]5 years old and dyspnea in children 5-11 years old should raise providers' index of suspicion for COVID-19. However, our overall findings underscore the limited diagnostic value of symptoms and the critical need for widely available, efficient testing.