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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 117 Research Studies Displayed
Portney DS, Zhu Z, Chen EM
COVID-19 and use of teleophthalmology (CUT Group): trends and diagnoses.
The coronavirus disease 2019 (COVID-19) pandemic altered how clinicians care for patients. Ophthalmologists saw an estimated 81% drop in volume, the most of any specialty during the initial pandemic and public health restrictions. This study demonstrates the characteristics of telehealth use in ophthalmology on a large scale with primary data before and during the COVID-19 pandemic.
AHRQ-funded; HS027632.
Citation:
Portney DS, Zhu Z, Chen EM .
COVID-19 and use of teleophthalmology (CUT Group): trends and diagnoses.
Ophthalmology 2021 Oct;128(10):1483-85. doi: 10.1016/j.ophtha.2021.02.010..
Keywords:
COVID-19, Telehealth, Health Information Technology (HIT), Healthcare Delivery
Baughman AW, Renton M, Wehbi NK
Building community and resilience in Massachusetts nursing homes during the COVID-19 pandemic.
Researchers discuss the partnership of the Massachusetts Senior Care Association and Hebrew SeniorLife with AHRQ ECHO National Nursing Home COVID-19 Action Network (the Network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes. The Network weekly meetings were a source of connection, emotional support, and validation and may be a valuable mechanism to support resilience and wellbeing for nursing home staff.
AHRQ-funded; 75Q80120C00003.
Citation:
Baughman AW, Renton M, Wehbi NK .
Building community and resilience in Massachusetts nursing homes during the COVID-19 pandemic.
J Am Geriatr Soc 2021 Oct;69(10):2716-21. doi: 10.1111/jgs.17389..
Keywords:
COVID-19, Elderly, Nursing Homes, Evidence-Based Practice, Provider: Health Personnel, Education: Continuing Medical Education, Training
Anesi GL, Kerlin MP
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Researchers discuss the impact of resource limitations on care delivery and outcomes. They conclude that the interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. Further, the COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and non-pandemic times.
AHRQ-funded; HS026372.
Citation:
Anesi GL, Kerlin MP .
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Curr Opin Crit Care 2021 Oct 1;27(5):513-19. doi: 10.1097/mcc.0000000000000859..
Keywords:
COVID-19, Public Health, Healthcare Delivery, Intensive Care Unit (ICU), Outcomes
Benneyan JC, White T, Nehls N
Systems analysis of a dedicated ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19 symptoms.
This paper is a systems analysis of a dedicated ambulatory respiratory unit for patients with COVID-19 symptoms. Workflow redesigns were necessitated by COVID and included new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. The workflow innovations observed can possibly be used to benefit routine care. Observations found that more than 85% of follow-ups were completed within 24 hours, and no staff or patient infections were associated with unit operations. Identified issues included role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns on the phone.
AHRQ-funded; HS027282.
Citation:
Benneyan JC, White T, Nehls N .
Systems analysis of a dedicated ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19 symptoms.
J Ambul Care Manage 2021 Oct-Dec;44(4):293-303. doi: 10.1097/jac.0000000000000390..
Keywords:
COVID-19, Ambulatory Care and Surgery, Respiratory Conditions, Workflow, Healthcare Delivery
Tignanelli CJ, Bramante CT, Dutta NT
Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease.
SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. The purpose of this observational study was to characterize the risk of hospitalization for COVID-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments.
AHRQ-funded; HS026379.
Citation:
Tignanelli CJ, Bramante CT, Dutta NT .
Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease.
Surg Obes Relat Dis 2021 Oct;17(10):1780-86. doi: 10.1016/j.soard.2021.05.029..
Keywords:
COVID-19, Surgery, Obesity: Weight Management, Obesity
Bartsch SM, Wedlock PT, O'Shea KJ
Lives and costs saved by expanding and expediting coronavirus disease 2019 vaccination.
The authors developed a computational model representing the United States population, COVID-19 coronavirus spread (February 2020-December 2022), and vaccination to determine the impact of increasing coverage and expediting time to achieve coverage. They concluded that their study quantified the potential value of decreasing vaccine hesitancy and increasing vaccination coverage and how this value may decrease with the time it takes to achieve coverage, emphasizing the need to reach high coverage levels as soon as possible, especially before the fall/winter.
AHRQ-funded; HS028165.
Citation:
Bartsch SM, Wedlock PT, O'Shea KJ .
Lives and costs saved by expanding and expediting coronavirus disease 2019 vaccination.
J Infect Dis 2021 Sep 17;224(6):938-48. doi: 10.1093/infdis/jiab233..
Keywords:
COVID-19, Vaccination, Public Health
Smulowitz PB, O'Malley AJ, Khidir H
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. In this study, the investigators examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not.
AHRQ-funded; HS025408.
Citation:
Smulowitz PB, O'Malley AJ, Khidir H .
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Health Aff 2021 Sep;40(9):1457-64. doi: 10.1377/hlthaff.2021.00561..
Keywords:
COVID-19, Public Health, Emergency Department, Hospitalization
Buxbaum JD, Rak S
Equity and the uneven distribution of federal COVID-19 relief funds To US hospitals.
This paper looked at the distribution of federal COVID-19 relief funds among US hospitals. The authors studied the relationship between the relief received by 2,709 hospitals and community- and hospital-level characteristics. Average funding through February 2021 was $25.7 million per hospital. They found that hospitals serving a community with a very high share of Black residents or having a very high ratio of Medicaid revenue to beds were associated with meaningful increased funding. However, hospitals with a very high share of Hispanic residents or a Medically Underserved Area were associated with decreased funding or no difference in funding.
AHRQ-funded; HS000055.
Citation:
Buxbaum JD, Rak S .
Equity and the uneven distribution of federal COVID-19 relief funds To US hospitals.
Health Aff 2021 Sep;40(9):1473-82. doi: 10.1377/hlthaff.2020.02018..
Keywords:
COVID-19, Hospitals
Johnson CL, Schwartz H, Greenberg A
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. The investigators concluded that eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
AHRQ-funded; HS024532.
Citation:
Johnson CL, Schwartz H, Greenberg A .
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
J Surg Res 2021 Aug;264:30-36. doi: 10.1016/j.jss.2021.01.028..
Keywords:
COVID-19, Surgery, Access to Care, Patient Experience, Public Health
Parmasad V, Keating JA, Carayon P
Physical distancing for care delivery in health care settings: considerations and consequences.
Physical distancing in high complexity systems such as health care is particularly challenging and may benefit from a human factors and systems engineering perspective. In this paper the investigators discussed challenges to implementing and maintaining physical distancing in health care settings and presented possible solutions from a human factors and systems engineering perspective.
AHRQ-funded; HS026226.
Citation:
Parmasad V, Keating JA, Carayon P .
Physical distancing for care delivery in health care settings: considerations and consequences.
Am J Infect Control 2021 Aug;49(8):1085-88. doi: 10.1016/j.ajic.2020.12.014..
Keywords:
COVID-19, Healthcare Delivery, Patient Safety
Klein IA, Rosenberg SM, Reynolds KL
Impact of cancer history on outcomes among hospitalized patients with COVID-19.
Researchers investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death in hospitalized patients with COVID-19. They found that patients with a history of cancer hospitalized for COVID-19 had similar mortality to matched hospitalized patients with COVID-19 without cancer, and a lower risk of complications, while patients with active cancer or recent cancer treatment had a similar risk for adverse outcomes compared with survivors of cancer. They concluded that active cancer, systemic cancer therapy, and a cancer history are not independent risk factors for death from COVID-19 among hospitalized patients, and hospitalized patients without cancer are more likely to have severe COVID-19.
AHRQ-funded; HS023680.
Citation:
Klein IA, Rosenberg SM, Reynolds KL .
Impact of cancer history on outcomes among hospitalized patients with COVID-19.
Oncologist 2021 Aug;26(8):685-93. doi: 10.1002/onco.13794..
Keywords:
COVID-19, Cancer, Risk, Mortality, Hospitalization, Outcomes
Khorasani SB, Koutoujian PJ, Zubiago J
COVID-19 vaccine interest among corrections officers and people who are incarcerated at Middlesex County jail, Massachusetts.
The Middlesex [Massachusetts] Sheriff’s Office developed and distributed two self-response surveys to assess COVID-19 vaccine willingness among people incarcerated in the jail and among people who work at the jail. The goal of this study was to characterize vaccine willingness in these two populations at the Middlesex House of Correction and Jail. Findings showed that 59% of people incarcerated in jail did not want the COVID-19 vaccine, while 82% of jail staff were interested in receiving the vaccine. Among people who were incarcerated, those who identified as Black had significantly decreased odds of wanting the vaccine compared to those who identified as white. Race was not significantly associated with vaccine willingness among jail employees when adjusting for role and gender.
AHRQ-funded; HS026008.
Citation:
Khorasani SB, Koutoujian PJ, Zubiago J .
COVID-19 vaccine interest among corrections officers and people who are incarcerated at Middlesex County jail, Massachusetts.
J Urban Health 2021 Aug;98(4):459-63. doi: 10.1007/s11524-021-00545-y..
Keywords:
COVID-19, Vaccination, Vulnerable Populations
Dixon BE, Grannis SJ, Lembcke LR
The synchronicity of COVID-19 disparities: statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America.
Researchers sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge. Data were taken from a statewide cohort of adult residents in Indiana tested for SARS-CoV-2 infection. The researchers found that, by the fall of 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Cumulative morbidity and mortality were highest among minority groups and in rural communities. They concluded that the synchronicity of disparities in COVID-19 by race and geography suggested that health officials explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.
AHRQ-funded; HS025502.
Citation:
Dixon BE, Grannis SJ, Lembcke LR .
The synchronicity of COVID-19 disparities: statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America.
PLoS One 2021 Jul 23;16(7):e0255063. doi: 10.1371/journal.pone.0255063..
Keywords:
COVID-19, Disparities, Racial / Ethnic Minorities, Hospitalization, Mortality, Rural Health
Ibrahim S, Lowe JR, Bramante CT
Metformin and Covid-19: focused review of mechanisms and current literature suggesting benefit.
In the current Covid-19 pandemic, four observational studies have been published showing reduced mortality among individuals with home metformin use. This article discusses these studies.
AHRQ-funded; HS026379.
Citation:
Ibrahim S, Lowe JR, Bramante CT .
Metformin and Covid-19: focused review of mechanisms and current literature suggesting benefit.
Front Endocrinol 2021 Jul 22;12:587801. doi: 10.3389/fendo.2021.587801..
Keywords:
COVID-19, Medication, Treatments
Byhoff E, Paulus JK, Guardado R
Healthcare workers' perspectives on coronavirus testing availability: a cross sectional survey.
This article describes a survey that was conducted during the first wave of the COVID pandemic during March-August 2020 of hospital workers on their perceptions of, access to, and receipt of COVID testing. A survey was given to all hospital employees in a single academic medical center in Boston, Massachusetts. A total of 2543 employees responded to the survey. Respondents were mostly female (76%), white (55%), with the mean age being 40 years. They were nurses (27%), administrators (22%), and patient support roles (22%) of which 56% of respondents wanted COVID testing. Age, full-time status, employment tenure, changes in quality of life, changes in job duties, and worries about enough sick paid leave were associated with testing. Nurses were more likely to want testing than administrators and patient support staff.
AHRQ-funded; HS026008.
Citation:
Byhoff E, Paulus JK, Guardado R .
Healthcare workers' perspectives on coronavirus testing availability: a cross sectional survey.
BMC Health Serv Res 2021 Jul 21;21(1):719. doi: 10.1186/s12913-021-06741-5..
Keywords:
COVID-19, Diagnosis, Provider: Health Personnel, Public Health
Dixon BE, Grannis SJ, McAndrews C BE, Grannis SJ, McAndrews C
Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: application of public health informatics.
Researchers sought to support public health surveillance and response to coronavirus disease 2019 (COVID-19) through rapid development and implementation of novel visualization applications for data amalgamated across sectors. Capitalizing on a statewide health information exchange, in partnership with health system and public health leaders, Regenstrief biomedical informatics experts rapidly developed and deployed informatics tools to support surveillance and response to COVID-19. The authors concluded that the application of public health informatics methods and tools in Indiana holds promise for other states and nations.
AHRQ-funded; HS025502.
Citation:
Dixon BE, Grannis SJ, McAndrews C BE, Grannis SJ, McAndrews C .
Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: application of public health informatics.
J Am Med Inform Assoc 2021 Jul 14;28(7):1363-73. doi: 10.1093/jamia/ocab004..
Keywords:
COVID-19, Health Information Exchange (HIE), Health Information Technology (HIT), Public Health
Choi KR, Martinez-Hollingsworth A, Mead M
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
The purpose of this retrospective case series was to describe adolescent psychiatric emergencies precipitated by the coronavirus disease 2019 (COVID-19) pandemic. Findings showed that COVID-19-precipitated admissions were 24% of total admissions from March 15 to May 31, 2020; however, total admissions during this time period were reduced from the same time period in prior years. The COVID-19 pandemic and corresponding shelter-in-place orders may precipitate psychiatric emergencies among adolescents both with and without existing mental health disorders.
AHRQ-funded; HS026407.
Citation:
Choi KR, Martinez-Hollingsworth A, Mead M .
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
J Psychosoc Nurs Ment Health Serv 2021 Jul;59(7):17-21. doi: 10.3928/02793695-20201203-05..
Keywords:
Children/Adolescents, COVID-19, Behavioral Health, Emergency Department
Chao GF, Li KY, Zhu Z
Use of telehealth by surgical specialties during the COVID-19 pandemic.
This study’s objective was to determine telehealth use by surgical specialty before and during the pandemic period starting in March 2020. Insurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020) were analyzed. For new patient visits, 1182 surgeons (26.8%) in any patient context used telehealth. Telehealth use peaked in April 2020 and facilitated 34.6% of all new patient visits during that week. Urology was the specialty with the highest telehealth conversion rate (14.3%).
AHRQ-funded; HS027632.
Citation:
Chao GF, Li KY, Zhu Z .
Use of telehealth by surgical specialties during the COVID-19 pandemic.
JAMA Surg 2021 Jul;156(7):620-26. doi: 10.1001/jamasurg.2021.0979..
Keywords:
COVID-19, Telehealth, Health Information Technology (HIT), Access to Care, Practice Patterns, Surgery
Clair K, Ijadi-Maghsoodi R, Nazinyan M
Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic.
This paper looks at veterans’ perspectives on adaptations made to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic. Adaptations to services are described within a large residential rehabilitation program for under-resourced veterans; reports veterans’ experiences; and outlines successes and challenges encountered. Data was collected from two focus groups with nine veterans in the program. The groups highlighted experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation.
AHRQ-funded; HS026407.
Citation:
Clair K, Ijadi-Maghsoodi R, Nazinyan M .
Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic.
Community Ment Health J 2021 Jul;57(5):801-07. doi: 10.1007/s10597-021-00810-z..
Keywords:
Veterans, Substance Abuse, Rehabilitation, COVID-19, Healthcare Delivery, Access to Care, Patient Experience
Tung EL, De Marchis EH, Gottlieb LM
Patient experiences with screening and assistance for social isolation in primary care settings.
Social isolation is a known predictor of mortality that disproportionately affects vulnerable populations in the USA. Although experts began to recognize it as a public health crisis prior to 2020, the novel coronavirus pandemic has accelerated recognition of social isolation as a serious threat to health and well-being. The objectives of this study were to examine patient experiences with screening and assistance for social isolation in primary care settings, and to determine whether patient experiences with these activities were associated with the severity of reported social isolation.
AHRQ-funded; HS026664; HS026383.
Citation:
Tung EL, De Marchis EH, Gottlieb LM .
Patient experiences with screening and assistance for social isolation in primary care settings.
J Gen Intern Med 2021 Jul;36(7):1951-57. doi: 10.1007/s11606-020-06484-9..
Keywords:
COVID-19, Patient Experience, Primary Care
Shipe ME, Haddad DN, Deppen SA
Modeling the impact of delaying the diagnosis of non-small cell lung cancer during COVID-19
The novel coronavirus (COVID-19) pandemic has led surgical societies to recommend delaying diagnosis and treatment of suspected lung cancer for lesions less than 2 cm. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. Delaying diagnosis can lead to disease progression, but the impact of this delay on mortality is unknown. In this study, the investigators sought to model immediate versus delayed surgical resection in a suspicious lung nodule less than 2 cm.
AHRQ-funded; HS026122.
Citation:
Shipe ME, Haddad DN, Deppen SA .
Modeling the impact of delaying the diagnosis of non-small cell lung cancer during COVID-19
Ann Thorac Surg 2021 Jul;112(1):248-54. doi: 10.1016/j.athoracsur.2020.08.025..
Keywords:
COVID-19, Cancer: Lung Cancer, Cancer, Diagnosis, Case Study, Risk
Bramante CT, Buse J, Tamaritz L
Outpatient metformin use is associated with reduced severity of COVID-19 disease in adults with overweight or obesity.
This study investigated whether outpatient metformin use is associated with reduced severity of COVID-19 in adults with overweight or obesity. Metformin can decrease interleukin-6 and tumor-necrosis factor- α, which appears to contribute to COVID-19 mortality. The authors conducted a retrospective cohort analysis of electronic health record (EHR) data that was pooled across multiple EHR systems from 12 hospitals and 60 primary care clinics in the Midwest between March and December 2020. Inclusion criteria included data for BMI > 25 kg/m(2); age range 30-85 years; and a positive SARS-CoV-2 polymerase chain reaction test. Metformin was associated with a decrease in mortality from COVID-19 and a nonsignificant decrease in hospital admission in the overall cohort.
AHRQ-funded; HS026379.
Citation:
Bramante CT, Buse J, Tamaritz L .
Outpatient metformin use is associated with reduced severity of COVID-19 disease in adults with overweight or obesity.
J Med Virol 2021 Jul;93(7):4273-79. doi: 10.1002/jmv.26873..
Keywords:
COVID-19, Infectious Diseases, Obesity, Medication, Treatments, Outcomes
Purnell TS, Simpson DC, Callender CO
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
As the United States faces unparalleled challenges due to COVID-19, racial disparities in health and healthcare have once again taken center stage. If effective interventions to address racial disparities in transplantation, including those magnified by COVID-19, are to be designed and implemented at the national level, it is first critical to understand the complex mechanisms by which structural, institutional, interpersonal, and internalized racism influence the presence of racial disparities in healthcare and transplantation. IN this article the authors discuss their viewpoint.
AHRQ-funded; HS024600.
Citation:
Purnell TS, Simpson DC, Callender CO .
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
Am J Transplant 2021 Jul;21(7):2327-32. doi: 10.1111/ajt.16543..
Keywords:
COVID-19, Racial / Ethnic Minorities, Disparities, Transplantation, Surgery, Access to Care
Arkhipova-Jenkins I, Helfand M, Armstrong C
Antibody response after SARS-CoV-2 infection and implications for immunity : a rapid living review.
This rapid literature review synthesizes evidence on the prevalence, levels, and durability of detectable antibodies after SARS-CoV-2 infection and whether the antibodies confer natural immunity. Seven databases were searched from January 1 to December 15, 2020, limited to peer-reviewed publications in English. Two investigators extracted study data and rated quality. Moderate-strength evidence suggested that most adults develop detectable levels of IgM and IgG antibodies after infection with SARS-CoV-2 and IgG levels peak approximately 25 days after symptom onset and can remain detectable for at least 120 days. Moderate-strength evidence suggested that IgM levels peak at approximately 20 days and then decline. There is low-strength evidence that most adults generate neutralizing antibodies. Reasons why some adults do not develop antibodies after SARS-CoV-2 are unclear.
AHRQ-funded; 290201700003C.
Citation:
Arkhipova-Jenkins I, Helfand M, Armstrong C .
Antibody response after SARS-CoV-2 infection and implications for immunity : a rapid living review.
Ann Intern Med 2021 Jun;174(6):811-21. doi: 10.7326/m20-7547..
Keywords:
COVID-19, Infectious Diseases, Genetics, Evidence-Based Practice
Becker AE, Chiotos K, McGuire JL
Intracranial hypertension in multisystem inflammatory syndrome in children.
The authors presented 4 patients with multisystem inflammatory syndrome in children who had intracranial hypertension and discussed the unique management considerations when this occurs concurrently with significant myocardial dysfunction.
AHRQ-funded; HS026393.
Citation:
Becker AE, Chiotos K, McGuire JL .
Intracranial hypertension in multisystem inflammatory syndrome in children.
J Pediatr 2021 Jun;233:263-67. doi: 10.1016/j.jpeds.2021.02.062..
Keywords:
Children/Adolescents, COVID-19, Critical Care, Case Study
