https://pubmed.ncbi.nlm.nih.gov/39489875/

Background

Post-acute sequelae of SARS-CoV-2 infection in children are individually uncommon and clinically diverse, which puts any single hospital far below the sample size needed for stable estimates. Two related questions were pursued: how much does infection raise the risk of specific syndromic and systemic outcomes, and how do risk factors behave once competing events are accounted for. Pediatric research networks supplied the scale.

Method

ODAP-B estimates adjusted relative risks through modified Poisson regression with a robust variance estimator, chosen because relative risk is more interpretable than an odds ratio when outcomes are rare. ODACoR extends the one-shot approach to competing risks, estimating subdistribution effects when several event types can preempt one another. The analyses covered 184,501 children across eight academic medical centers and, for the competing risks work, over 6.5 million pediatric patients.

Main finding

Elevated post-acute risk was detectable across both syndromic and systemic outcome categories, with age group, medical complexity, and intensive care during the acute episode among the factors carrying the strongest associations. Because event rates in several outcomes fall near half a percent, the pooled-equivalent estimates were the only ones stable enough to support these comparisons at the network level.