Clinical Features and Temporal Changes of RT-PCR and Chest CT in COVID-19 Pediatric Patients

Wei Xia; Yu Guo; Zhiyao Tian; Yan Luo; Daoyu Hu; Jianbo Shao; Zhen Li; Ihab R Kamel

doi:10.3389/fped.2020.579512

Clinical Features and Temporal Changes of RT-PCR and Chest CT in COVID-19 Pediatric Patients

Front Pediatr. 2020 Oct 9:8:579512. doi: 10.3389/fped.2020.579512. eCollection 2020.

Authors

Wei Xia¹, Yu Guo¹, Zhiyao Tian¹, Yan Luo², Daoyu Hu², Jianbo Shao¹, Zhen Li², Ihab R Kamel³

Affiliations

¹ Department of Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Johns Hopkins Med Institute, Baltimore, MD, United States.

Abstract

Objective: This work aims to investigate the clinical features and the temporal changes of RT-PCR and CT in COVID-19 pediatric patients. Methods: The clinical, RT-PCR, and CT features of 114 COVID-19 pediatric in-patients were retrospectively reviewed from January 21 to March 14, 2020. All patients had chest CT on admission and were identified as positive by pharyngeal swab nucleic acid test. The clinical features were analyzed, as well as the features and the temporal changes of RT-PCR and CT. Results: Fever (62, 54%) and cough (61, 54%) were the most common symptoms. There were 34 (30%) cases of concurrent infections. The most common imaging features on CT were ground-glass opacities (46, 40%) and consolidation (46, 40%). The bilateral lower lobes were the most common pattern of involvement, with 63 cases (55%) involving one to two lobes, and in 32 (28%) cases CT was normal. Throughout the whole duration of COVID-19 in children, the diagnostic positive rate of RT-PCR has been far higher than that of CT (all P < 0.05). For RT-PCR follow-up, reliable negative results were obtained only 7 days after the onset of symptoms. Though lung involvement on chest CT progressed rapidly in several cases, lung involvement in children with COVID-19 is mild, with a median value of 2 on CT score. Conclusions: RT-PCR is more reliable than CT in the initial diagnosis of pediatric patients with COVID-19. On follow-up, reliable negative RT-PCR results are available 7 days after the initial symptoms. The use of CT should be considered for follow-up purposes only if necessary.

Keywords: COVID-19; child; computer tomography; infection; polymerase chain reaction.