International Analysis of Children Hospitalized with COVID-19: Leveraging 4CE Electronic Health Record Data across 27 Hospitals in 6 Countries



Additional sources of pediatric epidemiological and clinical data are needed to efficiently study coronavirus disease 2019 (COVID-19) in children and inform infection prevention and clinical treatment of pediatric patients.


To describe international hospitalization trends and key epidemiological and clinical features of children with COVID-19.

Design, Setting, and Participants

We conducted a retrospective cohort study of patients <21 years who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were hospitalized at an institution participating in the Consortium for Clinical Characterization of COVID-19 by EHR (4CE). Patient-level electronic health record (EHR) data were abstracted for patients hospitalized between February 2 and October 10, 2020, across 27 hospitals in 6 countries.

Main Outcomes and Measures

Patient characteristics, clinical features, and medication use.


Trends in hospitalizations for 671 children mirrored national-level pediatric hospitalization trends for the majority of countries with available data. Hospitalized children were 52% male and demonstrated a bimodal age distribution, with the greatest proportion of patients in the 0–2 and 12–17-year age ranges. A total of 27,364 laboratory values for 16 laboratory tests were analyzed, with mean values indicating elevations in markers of inflammation (C-reactive protein 68 mg/L; ferritin 336 ng/mL; lactate dehydrogenase 316 U/L, and procalcitonin 0.33 ng/mL). Abnormalities in coagulation were also evident (D-dimer 550 ng/mL; fibrinogen 528 mg/dL; and prothrombin time 13.6 s). Cardiac troponin, when checked (n=59), was elevated (0.021 ng/mL). Common complications included respiratory failure (11.1%), viral pneumonia (9.2%), and shock (6.6%). Only 2 sites treated at least 3 patients with an aminoquinoline (e.g. hydroxychloroquine) and 1 site administered remdesivir to at least 3 patients.

Conclusions and Relevance

Large-scale informatics-based approaches used to incorporate EHR data across healthcare systems can provide an efficient source of information on pediatric patients hospitalized with COVID-19. These observational data complement other methods of disease surveillance and help define epidemiological and clinical features associated with COVID-19 in children.

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