BMC Medicine (Nov 2022)

Predictive model for long COVID in children 3 months after a SARS-CoV-2 PCR test

  • Manjula D. Nugawela,
  • Terence Stephenson,
  • Roz Shafran,
  • Bianca L. De Stavola,
  • Shamez N. Ladhani,
  • Ruth Simmons,
  • Kelsey McOwat,
  • Natalia Rojas,
  • Emma Dalrymple,
  • Emily Y. Cheung,
  • Tamsin Ford,
  • Isobel Heyman,
  • Esther Crawley,
  • Snehal M. Pinto Pereira

DOI
https://doi.org/10.1186/s12916-022-02664-y
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 11

Abstract

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Abstract Background To update and internally validate a model to predict children and young people (CYP) most likely to experience long COVID (i.e. at least one impairing symptom) 3 months after SARS-CoV-2 PCR testing and to determine whether the impact of predictors differed by SARS-CoV-2 status. Methods Data from a nationally matched cohort of SARS-CoV-2 test-positive and test-negative CYP aged 11–17 years was used. The main outcome measure, long COVID, was defined as one or more impairing symptoms 3 months after PCR testing. Potential pre-specified predictors included SARS-CoV-2 status, sex, age, ethnicity, deprivation, quality of life/functioning (five EQ-5D-Y items), physical and mental health and loneliness (prior to testing) and number of symptoms at testing. The model was developed using logistic regression; performance was assessed using calibration and discrimination measures; internal validation was performed via bootstrapping and the final model was adjusted for overfitting. Results A total of 7139 (3246 test-positives, 3893 test-negatives) completing a questionnaire 3 months post-test were included. 25.2% (817/3246) of SARS-CoV-2 PCR-positives and 18.5% (719/3893) of SARS-CoV-2 PCR-negatives had one or more impairing symptoms 3 months post-test. The final model contained SARS-CoV-2 status, number of symptoms at testing, sex, age, ethnicity, physical and mental health, loneliness and four EQ-5D-Y items before testing. Internal validation showed minimal overfitting with excellent calibration and discrimination measures (optimism-adjusted calibration slope: 0.96575; C-statistic: 0.83130). Conclusions We updated a risk prediction equation to identify those most at risk of long COVID 3 months after a SARS-CoV-2 PCR test which could serve as a useful triage and management tool for CYP during the ongoing pandemic. External validation is required before large-scale implementation.

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