P2A351: Outcomes of Nemours Children's Hospitals COVID-19 Treatment Algorithm Among COVID-19 Pneumonia Patients

Background: On August 20th, 2021, Nemours Children’s Hospitals introduced a treatment algorithm for moderate to severe pediatric COVID-19 cases. The guidelines recommended treatment according to the extent of the patient's respiratory support, which was divided into Group 1 – Group 4 of increasing severity. Currently the existing literature evaluating outcomes in relation to COVID-19 pneumonia pediatric cases is limited. Patient outcomes do not significantly differ between adherence vs. nonadherence to the 2021 Nemours COVID-19 Treatment Algorithm.

Methods: Retrospective chart review of 129 patients ≤18 years old diagnosed with COVID-19 pneumonia between January 1st, 2020 and July 1st 2022 at Nemours Children’s Health Florida and Delaware. Outcomes were evaluated through chi-squared and t-tests.

Results: The mortality rate of the study was 3.1%; 95% CI (0.9% - 7.7%).

Comparing adherence (N=63) vs. non-adherence (N=66) to the guidelines revealed significant differences in mean length of stay (10.9 vs. 6.7 days, p=0.05), pediatric risk of mortality (PRISM III) score (8.7 vs. 6.8, p=0.04), group 2 remdesivir usage (100% vs. 27.7%, p< 0.001), group 3 remdesivir usage (94.7% vs. 28.6%, p< 0.001), and group 3 enoxaparin usage (86.7% vs. 38.3%, p=0.002), respectively.

Comparing pre- (N=53) vs. post-guidelines (N=76) revealed a non-significance difference in the mean length of stay (10.7 vs. 7.3 days, p=0.124), PRISM III score (8.06 vs. 7.55, p=0.601), and a significant difference in group 1 stress ulcer prophylaxis (62.5% vs. 0.0%, p=0.005), respectively.

Conclusion: A longer length of stay and more severe disease was associated with greater adherence to the treatment guidelines. However, a greater severity of disease in the adherence group may account for the longer length in stay. Treatment that was adherent to the guidelines used more antiviral medication.