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Background The global COVID-19 pandemic was particularly concerning for the pediatric PH population due to immature immune systems and developmental comorbidities. This study aims to describe a single-center experience of pediatric PH patients diagnosed with COVID-19 disease. Methods Retrospective cohort study of all pediatric patients followed by the PH Center at Texas Children's Hospital diagnosed with COVID-19 infection from 04/2020 through 02/2021. Results We identified 23 patients with a median age of 58 months (IQR 25-75th, 21-132 months), 48% being Hispanics. Eight patients (35%) required hospitalization; median length of stay 6 days (IQR 25-75th , 5-8 days). Only three of these 8 patients required increased respiratory support. Targeted PH therapy was escalated in four patients (two in dual and two in triple therapy). There was one mortality in a patient with failing Fontan physiology. Ninety-one percent of patients have had post-COVID outpatient follow-up, median of 101 days (IQR 25-75th , 50-159 days) from diagnosis. Of the five patients with 6 minute walk test (6MWT) data, three (60%) children walked less distance, median -12 meters (IQR 25-75th , -12 - +49 meters) compared to pre-COVID testing. Post-infection pulmonary function testing (PFT) was notable for decrease in predicted forced vital capacity (FVC) (median -6%, range -11%-+6%) and forced expiratory volume in one second (FEV1) (median -14%, range -12- -18%) in 75% of the patients with PFT data. Conclusions In our institution, COVID-19 was found more frequently in Hispanics, and associated with low mortality. This article is protected by copyright. All rights reserved.

ObjectiveTo investigate effects of a cognitive intervention based on isolation of red flags (I-RED) on diagnostic accuracy of ‘do-not-miss diagnoses.’DesignA 2 × 2 randomized case vignette-based experiment with manipulation of I-RED strategy between subjects and case complexity within subjects.SettingTwo university-based residency programs.ParticipantsOne-hundred and nine pediatric residents from all levels of training.InterventionsParticipants were randomly assigned to the I-RED vs. control group, and within each group, they were further randomized to the order in which they saw simple and complex cases. The I-RED strategy involved an instruction to look for a constellation of symptoms, signs, clinical data or circumstances that should heighten suspicion for a serious condition.Main Outcome MeasuresPrimary outcome was diagnostic accuracy, scored as 1 if any of the three differentials given by participants included the correct diagnosis, and 0 if not. We analyzed effects of I-RED strategy on diagnostic accuracy using logistic regression.ResultsI-RED strategy did not yield statistically higher diagnostic accuracy compared to controls (62 vs. 48%, respectively; odd ratio = 2.07 [95% confidence interval, 0.78–5.5], P = 0.14) although participants reported higher decision confidence compared to controls (7.00 vs. 5.77 on a scale of 1 to 10, P ConclusionsA cognitive strategy of prompting red flag isolation prior to differential diagnosis did not improve diagnostic accuracy of ‘do-not-miss diagnoses.’ Given the paucity of evidence-based solutions to reduce diagnostic error and the intervention’s potential effect on confidence, findings warrant additional exploration.