Comparison of clinical features of COVID-19 vs febrile non-SARS-CoV-2 infections in hospitalized children

To define and compare the demographic data and clinical features of hospitalized children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) and non-SARS-CoV-2 etiology infections. This was an ambidirectional cohort study. Hospitalized children, aged ≤ 18 years, with COVID-19 (n=23) were enrolled retrospectively and febrile children with non-SARS-CoV-2 infections (n=32) were enrolled prospectively from March 2020 to December 2020. The clinical features and epidemiologic data were collected, assessed, and compared using descriptive statistics. The average age of children in COVID-19 group was 6,9 years, median age 7 years. In the non-SARS-CoV-2 (control) group the average age was 3,8 years, median – 2,7. Female patients were predominant in both groups – 65% and 53%, respectively. Participants were divided into 5 age groups (< 1 year; 1 – 4; 5 – 9; 10 – 14; 15 – 18 years). In COVID-19 group the age distribution was equal (about 20% each), in the control group mostly children aged 1 to 4 years were represented (72%, n=23). The mean time between symptom onset and hospitalization was 3,8 days in the COVID-19 group and 5,5 days in the control group. The average hospital length of stay was 4 days in both groups, ranging from 1 to 22 days in COVID-19 group and 1 to 19 in the non-COVID-19 group.The clinical symptoms were quite similar between both groups. The most common symptoms were fever (96% and 100%, respectively), congestion or runny nose (87%; 56%), fatigue (48%; 75%) and sore throat (43%; 53%). Although differences in clinical features were found between the groups, significant overlap in presentation was noted. Clinical symptoms alone should not be used to identify COVID-19 patients. During the pandemic, every child with fever or signs of infection should be perceived as potentially SARS-CoV-2 positive and PPE should be used accordingly.