Symptom patterns and life with post-acute COVID-19 in children aged 8-17: a mixed methods studyprotocol

Abstract:

Background: While there is a substantial body of knowledge about acute COVID-19, less is known about long-COVID, where symptoms continue beyond four weeks.

Aim: This study aims to describe longer-term effects of COVID-19 infection in children and young people (CYP) and identify their needs in relation to long-COVID.

Design & setting: This study comprises an observational prospective cohort study and a linked qualitative study, identifying participants aged 8-17 years in the West Midlands of England.

Method: CYP will be invited to complete online questionnaires to monitor incidences and symptoms of Covid-19 over a 12-month period. CYP who have experienced long-term effects of COVID will be invited to interview, and those currently experiencing symptoms will be asked to document their experiences in a diary. Professionals who work with CYP will be invited to explore the impact of long-COVID on the wider experiences of CYP, in a focus group. Descriptive statistics will be used to describe the incidence and rates of resolution of symptoms, and comparisons made between exposed and non-exposed groups. Logistic regression models will be used to estimate associations between candidate predictors and the development of long-COVID, and linear regression will be used to estimate associations between candidate predictors. Qualitative data will be analysed thematically using the constant comparison method.

Conclusion: This study will describe features and symptoms of long-COVID and explore the impact of long-COVID within the lives of CYP and their families, to provide better understanding of long-COVID and inform clinical practice.

Source: Faux-Nightingale A, Burton C, Twohig H, Blagojevic-Bucknall M, Carroll W, Chew-Graham CA, Dunn K, Gilchrist F, Helliwell T, Lawton O, Lawton S, Mallen C, Saunders B, van der Windt D, Welsh V. Symptom patterns and life with post-acute COVID-19 in children aged 8-17: a mixed methods studyprotocol. BJGP Open. 2023 Feb 9:BJGPO.2022.0149. doi: 10.3399/BJGPO.2022.0149. Epub ahead of print. PMID: 36759021. https://bjgpopen.org/content/early/2023/02/08/BJGPO.2022.0149 (Full text available as PDF file)

Comparability of control and comparison groups in studies assessing long COVID

Abstract:

Background: Awareness of long COVID began primarily through media and social media sources, which eventually led to the development of various definitions, based on methodologies of varying quality. We sought to characterize comparison groups in long COVID studies and evaluate comparability of the different groups.

Methods: We searched Embase, Web of Science, and PubMed for original research articles published in high-impact journals. We included studies on human patients with long COVID outcomes, and we abstracted study-related characteristics, as well as long COVID characteristics.

Results: Of the 83 studies, 3 were RCTs testing interventions for long COVID, and 80 (96.4%) were observational studies. Among the 80 observational studies, 76 (95%) were trying to understand the incidence, prevalence, and risk factors for long COVID, two (2.5%) examined prevention strategies, and 2 (2.5%) examined treatment strategies. Among those 80 studies, 45 (56.2%) utilized a control or comparison group and 35 (43.8%) did not. Compared to 95% of observational studies that documented symptoms or assessed risk factors, all randomized studies assessed treatment strategies. We found 48.8% of observational studies did any adjustment for covariates, including demographics or health status. Of those that did adjust for covariates, 15 (38.5%) adjusted for four or fewer variables. We found that 26.5% of all studies and 45.8% of studies with a control/comparator group matched participants on at least one variable.

Conclusion: Long COVID studies in high-impact journals primarily examine symptoms and risk factors of long COVID, often lack an adequate comparison group, and often do not control for potential confounders. Our results suggest that standardized definitions for long COVID, which are often based on data from uncontrolled and potentially biased studies, should be reviewed to ensure that they are based on objective data.

Source: Haslam A, Prasad V. Comparability of control and comparison groups in studies assessing long COVID. Am J Med. 2023 Jan 25:S0002-9343(23)00038-4. doi: 10.1016/j.amjmed.2023.01.005. Epub ahead of print. PMID: 36708796. https://pubmed.ncbi.nlm.nih.gov/36708796/