83 - Incidence of Depressed Systolic Function in Pediatric Patients with Acute SARS-CoV-2 Infection

Poster Number: 83
Publication Number: 83.106

Adrienne N. Smallwood, Texas Children's Hospital, Houston, TX, United States; Charlene Walton, Baylor College of Medicine, HOUSTON, TX, United States; Elizabeth A. Camp, Baylor College of Medicine, Houston, TX, United States; Stephanie K. Leung, Baylor College of Medicine / Texas Children's Hospital, Houston, TX, United States; Alan Riley, Baylor College of Medicine, Houston, TX, United States; Kiyetta Alade, Baylor College of Medicine, Houston, TX, United States

Background: SARS-CoV-2 infection is associated with myocardial injury in adult patients, and multisystem Inflammatory Syndrome in children (MIS-C) is known to cause cardiac dysfunction in pediatric patients following a SARS-CoV-2 infection. The timing of the development of depressed cardiac function in children with acute SARS-CoV2 infection is not well described.

Objective: The primary aim was to quantify the incidence of depressed systolic function and pericardial effusion on cardiac Point of Care Ultrasound (POCUS) in pediatric patients with acute SARS-CoV-2 infection upon presentation to the emergency department (ED). We hypothesized that patients with SARS-CoV-2 infection would have a greater incidence of depressed cardiac function on POCUS.

Design/Methods: Children aged 0-18 years were prospectively and retrospectively enrolled at a quaternary care children’s hospital from May 2020 – May 2021. POCUS results and clinical data were reviewed for patients presenting as a person of interest for acute SARS-CoV-2 infection. Patients with known pre-existing depressed cardiac function, cardiac arrest, or a diagnosis of MIS-C were excluded. POCUS exams were independently interpreted by POCUS fellowship-trained faculty and a pediatric cardiologist. The incidence of depressed cardiac function and pericardial effusion in pediatric patients with acute SARS- CoV-2 infection were quantified.

Results: A total of 338 patients met inclusion criteria. Among enrolled patients, 19.8%(Nf67) were COVID PCR positive and 80.2%(Nf271) were COVID negative. Patients positive for SARS-CoV-2 were more likely to be older (14.1 vs. 8.97, P < 0.0010), Hispanic (64.2%, P=0.03), and obese (18% vs. 5%, P=0.01)(Table 1).
None of the SARS-CoV-2 positive patients had depressed cardiac function or pericardial effusion on bedside or POCUS faculty review. In SARS-CoV-2 negative patients, 4%(Nf11) had depressed cardiac function and 4%(Nf11) had pericardial effusion. The frequency of detection of abnormal function or pericardial effusion was similar between scanners and POCUS faculty with an overall sensitivity >90% and specificity close to 100% (Tables 2 and 3). Inter-rater reliability between faculty and scanners was strong (κ > 0.86; p-value < 0.001). Inter-rater reliability between POCUS faculty and cardiology review were moderate for both function and effusions (κ = 0.65 and κ = 0.79, respectively)Conclusion(s): These findings suggest that depressed cardiac function or pericardial effusion are not a frequent component of the presentation of acute SARS-CoV-2 infection in children.  There was excellent correlation between scanners and POCUS Faculty.
Table 1. Comparison of patient demographics and COVID status (N = 338).* Includes Hawaiian residents and biracial people
Table 2. Comparison of POCUS results between positive and negative COVID patients (N = 338).a = P-value calculated using the Fisher’s Exact test for cell values < 5