COVID-19 is Observed in Older Children During the Omicron Wave in New York City

• Published in: The Journal of emergency medicine 2023-02, Vol.64 (2), p.195-199
• Main Authors: Narayanan, Nisha, Langer, Samantha, Acker, Karen P., Rosenblatt, Steven D., Simmons, Will, Wu, Alan, Han, Jin-Young, Abramson, Erika L., Grinspan, Zachary M., Levine, Deborah A.
• Format: Article
• Language: English
• Subjects: Child; COVID-19; Cross-Sectional Studies; Croup; Humans; laryngotracheitis; New York City; Pandemics; Respiratory Sounds; Respiratory Tract Infections; SARS-CoV-2
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2022.09.036

The Omicron variant of SARS-CoV-2 has a predilection for the upper airways, causing symptoms such as sore throat, hoarse voice, and stridor. We describe a series of children with COVID-19–associated croup in an urban multicenter hospital system. We conducted a cross-sectional study of children ≤18 years of age presenting to the emergency department during the COVID-19 pandemic. Data were extracted from an institutional data repository comprised of all patients who were tested for SARS-CoV-2. We included patients with a croup diagnosis by International Classification of Diseases, 10th revision code and a positive SARS-CoV-2 test within 3 days of presentation. We compared demographics, clinical characteristics, and outcomes for patients presenting during a pre-Omicron period (March 1, 2020–December 1, 2021) to the Omicron wave (December 2, 2021–February 15, 2022). We identified 67 children with croup, 10 (15%) pre-Omicron and 57 (85%) during the Omicron wave. The prevalence of croup among SARS-CoV-2–positive children increased by a factor of 5.8 (95% confidence interval 3.0–11.4) during the Omicron wave compared to prior. More patients were ≥6 years of age in the Omicron wave than prior (19% vs. 0%). The majority were not hospitalized (77%). More patients ≥6 years of age received epinephrine therapy for croup during the Omicron wave (73% vs. 35%). Most patients ≥6 years of age had no croup history (64%) and only 45% were vaccinated against SARS-CoV-2. Croup was prevalent during the Omicron wave, atypically affecting patients ≥6 years of age. COVID-19–associated croup should be added to the differential diagnosis of children with stridor, regardless of age. © 2022 Elsevier Inc.