COVID-19 is Observed in Older Children During the Omicron Wave in New York City

Background: The Omicron variant of SARS-CoV-2 has a predilection for the upper airways, causing symptoms such as sore throat, hoarse voice, and stridor. Objective: We describe a series of children with COVID-19-associated croup in an urban multicenter hospital system. Methods: We conducted a cross-sectional study of children <18 years of age presenting to the emergency department during the COVID-19 pandemic. Data were extracted from an institutional data repository comprised of all patients who were tested for SARS-CoV-2. We included patients with a croup diagnosis by International Classification of Diseases, 10th revision code and a positive SARS-CoV-2 test within 3 days of presentation. We compared demographics, clin-ical characteristics, and outcomes for patients presenting during a pre-Omicron period (March 1, 2020-December 1, 2021) to the Omicron wave (December 2, 2021-February 15, 2022). Results: We identified 67 children with croup, 10 (15%) pre-Omicron and 57 (85%) during the Omicron wave. The prevalence of croup among SARS-CoV-2-positive children increased by a factor of 5.8 (95% confidence inter-val 3.0-11.4) during the Omicron wave compared to prior. More patients were >6 years of age in the Omicron wave than prior (19% vs. 0%). The majority were not hospitalized (77%). More patients >6 years of age received epinephrine therapy for croup during the Omicron wave (73% vs. 35%). Most patients >6 years of age had no croup history (64%) and only 45% were vaccinated against SARS-CoV-2. Con-clusion: Croup was prevalent during the Omicron wave, atypically affecting patients >6 years of age. COVID-19-associated croup should be added to the differential diagno-sis of children with stridor, regardless of age. (c) 2022 Elsevier Inc. (c) 2022 Elsevier Inc. All rights reserved.