Assessing the Number of Children Evaluated for Recurrent Fevers During the COVID-19 Pandemic in North America
Author Type(s)
Faculty
Document Type
Abstract
Publication Date
2022
DOI
10.1002/art.42355
Journal Title
Arthritis and Rheumatology
Department
Pediatrics
Abstract
Background/Purpose: The impact of the COVID-19 pandemic on the number of pediatric patients evaluated in North America for recurrent fevers and autoinflammatory diseases is unknown; however, there have been reports of increased numbers of children presenting with these concerns. The purpose of this project was to determine the number of new patients evaluated for recurrent fevers in temporal relation to the COVID-19 pandemic in North America. Methods: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis Syndrome (PFAPA)/Autoinflammatory Disease Working Group used previously determined recurrent fever ICD-10 codes, including periodic fever and autoinflammatory syndromes, to quantify monthly numbers of new pediatric patients evaluated for recurrent fever diagnoses by outpatient subspecialists from March 1, 2019 to February 29, 2020 (pre-pandemic) and from March 1, 2020 to February 28, 2021 (during the pandemic). The proportion of new visits evaluated for recurrent fever diagnoses relative to all new visit diagnoses during these two years were compared using a two-sample test of proportions. This study was determined to be IRB exempt by the Cincinnati Children's Hospital IRB. Results: Twenty-four sites reported 1684 new patient visits coded with recurrent fever diagnoses pre-pandemic compared with 2181 during the first year of the pandemic. There was an increase in the total number of recurrent fever evaluations after the onset of the pandemic compared to the year prior in 20 of 24 sites (range-48% to +360%). Of the 20 sites who provided the total number of new visits for all diagnoses, there were 19305 new visits pre-pandemic of which 1318 (6.83%) had a recurrent fever code compared to 17040 new visits during the pandemic with 1690 (9.92%) who received a recurrent fever diagnosis code. The difference between the proportion of new recurrent fever evaluations and total number of new visits pre-pandemic versus during the pandemic was statistically significant (p< 0.0001). Conclusion: Across 24 CARRA-associated North American centers, there was an increase in pediatric patients evaluated for new recurrent fever diagnoses during the first year of the COVID-19 pandemic compared to the year prior, despite a decrease in the total number of new patients. An increase in recurrent fever evaluations merits further investigation given that many daycare centers and schools were closed during a time of increased infection control precautions and attention to fevers. A speculated potential etiology is that unknown, noninfectious triggers precipitate recurrent fever syndromes. The CARRA PFAPA/Autoinflammatory Disease Working Group's project is the first collaborative, multidisciplinary effort to assess the number of children evaluated for recurrent fevers in relation to the COVID-19 pandemic in North America.
Recommended Citation
Mansfield, L., Lapidus, S., Hollander, M., Cherian, J., Twilt, M., Piram, M., Moorthy, L., Nolan, B., Lionetti, G., Wu, E., Tory, H., Kessler, E., Aguiar, C., Panupattanapong, S., Akoghlanian, S., Adler-Shohet, F., Oliver, M., Mohan, S., DelaMora, P., Durrant, K., Muskardin, T. W., Nazzar, S., Marques, M. C., Basiaga, M., Vogel, T., Lai, J., Edwards, K., Garguilo, K., Nolan, S., Scarcello, E. S., Alonzi, G., Szymanski, A., Hui-Yuen, J., Onel, k., Dedeoglu, F., Gutierrez, M., & Schulert, G. (2022). Assessing the Number of Children Evaluated for Recurrent Fevers During the COVID-19 Pandemic in North America. Arthritis and Rheumatology, 74, 3817-3818. https://doi.org/10.1002/art.42355
