240 - Validation of a Pediatric Post-Acute Sequelae of SARS-CoV-2 Symptom Index Score

Publication Number: 240.7084

Frederick Dun-Dery, University of Ca=ary Cumming School of Medicine, Calgary, AB, Canada; Jianling Xie, University of Calgary, Calagary, AB, Canada; Kathleen Winston, University of Calgary, Calgary, AB, Canada; Brett Burstein, Montreal Chilren's Hospital, McGill University Helath Centre, Montreal, PQ, Canada; Vikram Sabhaney, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; April J.. Kam, McMaster University Michael G. DeGroote School of Medicine, Hamilton, ON, Canada; Jason Emsley, Dalhousie University Faculty of Medicine, Halifax, NS, Canada; Darcy Beer, University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, MB, Canada; Jocelyn Gravel, Université de Montreal, Montréal, PQ, Canada; Roger Zemek, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada; Gabrielle Freire, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Ahmed Mater, University of Saskatchewan, Saskatoon, SK, Canada; Simon Berthelot, Université Laval, Québec, PQ, Canada; Robert Porter, Memorial University of Newfoundland, St. John's, NF, Canada; Naveen Poonai, The University of Western Ontario - Schulich School of Medicine & Dentistry, Dorchester, ON, Canada; Anne Moffatt, Queen's University Faculty of Health Sciences, Kingston, ON, Canada; Marina I. Salvadori, Public Health Agency of Canada, London, ON, Canada; Andrew Dixon, University of Alberta, Edmonton, AB, Canada; Stephen Freedman, University of Calgary, Calgary, AB, Canada

Background: Post-Acute Sequelae of SARS-CoV-2 (PASC) remains a significant concern among children and adolescents. There is no standardized approach to diagnosing PASC. Symptoms often overlap with other illnesses and can be reported by healthy children. The RECOVER (REsearching COVid to Enhance Recovery) initiative derived a score to identify children with PASC.

Objective: We aimed to externally evaluate the RECOVER study's PASC score in a sample of children tested for acute SARS-CoV-2 infection who were followed for 12 months to assess for the presence of prolonged symptoms.

Design/Methods: This was a secondary analysis of a prospective cohort of children (6-18 years) enrolled between August 2020 and February 2022, with symptoms associated with acute SARS-CoV-2 infection and tested in 14 pediatric emergency departments of the Pediatric Emergency Research Canada (PERC) Network. Participants subsequently reported ongoing symptoms at 6- and 12-months post-recruitment in a standardized questionnaire. At each time-point, PASC scores were calculated, and participants were categorized as meeting PASC criteria based on age-specific (6 - < 12 years; 12 - < 18 years) cut-points. Presence of PASC, per the RECOVER study's PASC score, was compared between SARS-CoV-2 positive and negative participants. Finally, we assessed PASC score construct and concurrent validity and reliability.

Results: 785 children, with a median age of 9 years (IQR: 7, 13), who completed at least one of the follow-up surveys, were included. PASC scores did not differ between SARS-CoV-2-positive and negative children in the 6- < 12 age group (25% vs 22%; aOR: 1.2;CI 0.6, 2.4) and the 12- < 18 age group (18% vs 10%; aOR: 2.0;CI 0.5, 8.2) at 6-months or 12-months (6- < 12: 27% vs 32%; aOR: 0.8;CI 0.5, 1.4) 12- < 18: 17% vs 14%; aOR: 1.3;CI 0.5, 3.5), respectively. Factor analysis identified several thematic factors that varied by age group and follow-up time-point (e.g., physical and psychological/anxiety or cognitive; physical and fearfulness/memory; physical and fatigue) that accounted for 32-40% of the variance. Strong correlations were identified between PASC scores and PedsQL and caregiver rating of their child's overall health status; however internal reliability (Cronbach's α) ranged from 0.49-0.67 (low to acceptable range).

Conclusion(s): The PASC score did not differentiate between SARS-CoV-2 positive and negative participants. Domains identified in factor analysis accounted for a limited degree of the variance observed. While the PASC score correlated with quality of life and overall health, internal reliability was in the low to acceptable range.

Baseline demographics stratified by SARS-CoV-2 test status and age groups, for all participants who completed the 6- or 12-month follow-up surveys
Table 1.pdf†COVID vaccination status data collection implemented June 11, 2021, 10 months after study start.
* Applicable to children who tested positive for SARS-CoV-2.

Post-Acute Sequelae of COVID-19 Index scores categorized based on proposed cut-points compared between compared based on index emergency department visit SARS-CoV-2 test result (i.e., positive vs. negative).
Table 2.pdf* Odds ratios were obtained from logistic regression fitted in generalized estimating equation (GEE) model with binary outcome being the PASC Index score exceeding the threshold level, with the model adjusted for clustering by site. Separate GEE models were used for each subgroup included in this table.

Figure 1. Scatter plots for relationship between Post-Acute Sequelae of COVID-19 and PedQL scores.
Figure.pdfThis plot illustrates the correlation between PASC scores and PedsQL scores at 6- and 12-month follow-up periods. Each point represents an individual child or adolescent, with a negative correlation showing that higher PASC scores are linked to lower quality of life.