PDF(Pubmed)
Abstract：
OBJECTIVE: This study seeks to identify demographic and clinical factors prompting clinician prescribing of nirmatrelvir/ritonavir to pediatric patients for management of coronavirus disease 2019 (COVID-19) infection.
METHODS: Patients aged 12 to 17 years with a COVID-19 infection and nirmatrelvir/ritonavir prescription during an outpatient clinical encounter within a PEDSnet-affiliated institution between January 2022 and August 2023 were identified using electronic health record data. A multivariate logistic regression analysis was used to estimate odds of nirmatrelvir/ritonavir prescription after adjusting for various factors.
RESULTS: A total of 20 959 patients aged 12 to 17 years were diagnosed with a COVID-19 infection on the basis of an electronic health record-documented positive polymerase chain reaction or antigen test or diagnosis during an outpatient clinical visit. Of these patients, 408 received a nirmatrelvir/ritonavir prescription within 5 days of diagnosis. Higher odds of nirmatrelvir/ritonavir treatment were associated with having chronic or complex chronic disease (chronic: odds ratio [OR] 2.50 [95% confidence interval (CI) 1.83-3.38]; complex chronic: OR 2.21 [95% CI 1.58-3.08]). Among patients with chronic disease, each additional body system conferred 1.18 times higher odds of treatment (95% CI 1.10-1.26). Compared with non-Hispanic white patients, Hispanic patients (OR 0.61 [95% CI 0.44-0.83]) had lower odds of treatment.
CONCLUSIONS: Children with chronic conditions are more likely than those without to receive nirmatrelvir/ritonavir prescriptions. However, nirmatrelvir/ritonavir prescribing to children with chronic conditions remains infrequent. Pediatric data concerning nirmatrelvir/ritonavir safety and effectiveness in preventing severe disease and hospitalization are critical optimizing clinical decision-making and use among children.
METHODS: Patients aged 12 to 17 years with a COVID-19 infection and nirmatrelvir/ritonavir prescription during an outpatient clinical encounter within a PEDSnet-affiliated institution between January 2022 and August 2023 were identified using electronic health record data. A multivariate logistic regression analysis was used to estimate odds of nirmatrelvir/ritonavir prescription after adjusting for various factors.
RESULTS: A total of 20 959 patients aged 12 to 17 years were diagnosed with a COVID-19 infection on the basis of an electronic health record-documented positive polymerase chain reaction or antigen test or diagnosis during an outpatient clinical visit. Of these patients, 408 received a nirmatrelvir/ritonavir prescription within 5 days of diagnosis. Higher odds of nirmatrelvir/ritonavir treatment were associated with having chronic or complex chronic disease (chronic: odds ratio [OR] 2.50 [95% confidence interval (CI) 1.83-3.38]; complex chronic: OR 2.21 [95% CI 1.58-3.08]). Among patients with chronic disease, each additional body system conferred 1.18 times higher odds of treatment (95% CI 1.10-1.26). Compared with non-Hispanic white patients, Hispanic patients (OR 0.61 [95% CI 0.44-0.83]) had lower odds of treatment.
CONCLUSIONS: Children with chronic conditions are more likely than those without to receive nirmatrelvir/ritonavir prescriptions. However, nirmatrelvir/ritonavir prescribing to children with chronic conditions remains infrequent. Pediatric data concerning nirmatrelvir/ritonavir safety and effectiveness in preventing severe disease and hospitalization are critical optimizing clinical decision-making and use among children.
摘要：
■这项研究旨在确定人口统计学和临床因素，促使临床医生为儿科患者开具尼马特雷韦/利托那韦，以治疗2019年冠状病毒病（COVID-19）感染。
在2022年1月至2023年8月期间，在PEDSnet附属机构的门诊临床治疗期间，使用电子健康记录数据确定了12至17岁患有COVID-19感染和尼马特雷韦/利托那韦处方的患者。在调整各种因素后，使用多变量逻辑回归分析来估计尼马特雷韦/利托那韦处方的几率。
■在门诊就诊期间，根据电子健康记录记录的阳性聚合酶链反应或抗原测试或诊断，共有20959名12至17岁的患者被诊断出患有COVID-19感染。在这些病人中,408在诊断后5天内接受了尼马特雷韦/利托那韦处方。尼马特雷韦/利托那韦治疗的几率较高与患有慢性或复杂慢性疾病相关(慢性:比值比[OR]2.50[95%置信区间(CI)1.83-3.38];复杂慢性:OR2.21[95%CI1.58-3.08])。在慢性病患者中，每增加一个身体系统,治疗的几率提高1.18倍(95%CI1.10-1.26).与非西班牙裔白人患者相比，西班牙裔患者（OR0.61[95％CI0.44-0.83]）的治疗几率较低。
■患有慢性疾病的儿童比没有接受尼马特雷韦/利托那韦处方的儿童更有可能。然而,nirmatrelvir/ritonavir为患有慢性疾病的儿童开处方仍然很少见。有关尼马特雷韦/利托那韦预防严重疾病和住院的安全性和有效性的儿科数据是优化儿童临床决策和使用的关键。
在2022年1月至2023年8月期间，在PEDSnet附属机构的门诊临床治疗期间，使用电子健康记录数据确定了12至17岁患有COVID-19感染和尼马特雷韦/利托那韦处方的患者。在调整各种因素后，使用多变量逻辑回归分析来估计尼马特雷韦/利托那韦处方的几率。
■在门诊就诊期间，根据电子健康记录记录的阳性聚合酶链反应或抗原测试或诊断，共有20959名12至17岁的患者被诊断出患有COVID-19感染。在这些病人中,408在诊断后5天内接受了尼马特雷韦/利托那韦处方。尼马特雷韦/利托那韦治疗的几率较高与患有慢性或复杂慢性疾病相关(慢性:比值比[OR]2.50[95%置信区间(CI)1.83-3.38];复杂慢性:OR2.21[95%CI1.58-3.08])。在慢性病患者中，每增加一个身体系统,治疗的几率提高1.18倍(95%CI1.10-1.26).与非西班牙裔白人患者相比，西班牙裔患者（OR0.61[95％CI0.44-0.83]）的治疗几率较低。
■患有慢性疾病的儿童比没有接受尼马特雷韦/利托那韦处方的儿童更有可能。然而,nirmatrelvir/ritonavir为患有慢性疾病的儿童开处方仍然很少见。有关尼马特雷韦/利托那韦预防严重疾病和住院的安全性和有效性的儿科数据是优化儿童临床决策和使用的关键。
