Clinical Features and Outcomes of Pediatric and Adult Patients Hospitalized for Covid-19: A Comparison across Age Strata

COVID-19 continues to cause hospitalizations and severe disease in children and adults. This study compared the risk factors, symptoms, and outcomes of children and adults hospitalized for COVID-19 from March 2020 to May 2023 across age strata at five US sites participating in the PreVAIL consortium. Eligible patients had an upper respiratory swab that tested positive for SARS-CoV-2 by nucleic acid amplification. Adjusted odds ratios of clinical outcomes were determined for children versus adults, for pediatric age strata compared to adolescents (12-17 years), and for adult age strata compared to young adults (22-49 years). Of 9101 patients in the PreVAIL cohort, 1560 were hospitalized for COVID-19 as the primary reason. Compared to adults (22-105 years, n=675), children (0-21 years, n=885) were less commonly vaccinated (14.3% vs. 34.5%), more commonly infected with the Omicron variant (49.5% vs. 26.1%) and had fewer comorbidities (p<0.001 for most comparisons), except for lung disease (p = 0.24). After adjusting for confounding variables, children had significantly lower odds of receiving supplemental oxygen (aOR 0.57, 95%CI 0.35, 0.92) and death (aOR 0.011, 95%CI <0.01, 0.58) compa­­red to adults. Among pediatric age strata, adolescents 12-17 years had the highest odds of receiving supplemental oxygen, high-flow oxygen, and ICU admission. Among adults, those 50-64 years had the highest odds of mechanical ventilation and ICU admission. Clinical outcomes of COVID-19 differed across pediatric and adult age strata. Adolescents experienced the most severe disease among children, while adults 50-64 years experienced the most severe disease among adults.