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Table 4 Results of the two rounds of Delphi survey

From: Methodology and experiences of rapid advice guideline development for children with COVID-19: responding to the COVID-19 outbreak quickly and efficiently

  First Round Delphi Process (results from 33 panelists) Second Round Delphi Process (results from 30 panelists)
  Preliminary recommendation (1st round) Level of agreement How many panelists gave comments Total number of comments Preliminary recommendation (2nd round) Level of Agreement How many panelists gave comments Total number of comments
CQ1 The main symptoms of children with COVID-19 are fever and cough. The symptoms of COVID-19 are usually less severe in children than adults. Leukocyte and lymphocyte counts are usually normal. Chest imaging findings do not significantly differ between adults and children. (2C) 94% (Consensus) 10 11 The main symptoms of children with COVID-19 are fever and cough. The symptoms of COVID-19 are usually less severe in children than adults. Leukocyte and lymphocyte counts are usually normal. Although there is no significant difference between adults and children in chest imaging characteristics, the extend of the abnormalities are usually less in children. (2C) NA 8 11
CQ2 We recommend that children who have been in close contact with COVID-19 patients are initially evaluated by their guardians or family doctors. If no obvious symptoms are found, we recommend staying at home for observation; if there are obvious symptoms such as fever and cough, we recommend further evaluation in the hospital. (2C) 94% (Consensus) 9 11 We suggest that children who have been in close contact with COVID-19 patients are initially evaluated by their guardians or family doctors. If no obvious symptoms occur, we recommend staying at home for observation for a duration of at least 14 days; if there are obvious symptoms, we suggest further evaluation in the hospital. (2C) NA 9 12
CQ3 We recommend X-ray rather than CT to assist in diagnosis of COVID-19 in children if necessary. (2C) 55% (Not consensus) 13 16 We suggest not using imaging test as routine examination for children with COVID-19. (2C) 79% (Consensus) 11 13
CQ4 We recommend against using antiviral drugs for children with COVID-19. Specific antiviral drugs may be administered only in the context of clinical trial (1C) 94% (Consensus) 7 9 We recommend against using antiviral drugs for children with COVID-19. Specific antiviral drugs may be administered only in the context of clinical trial. (1C) NA 4 7
CQ5 We recommend against the use of antibiotic agents for children with COVID-19 when there is no evidence of bacterial coinfection. (1B) 100% (Consensus) 2 3 We recommend against using antibiotic agents for children with COVID-19 when there is no evidence of bacterial coinfection. (1B) NA 1 1
CQ6 We recommend using systemic glucocorticoids with a low dose and for a short duration for children with severe COVID-19. (2C) 79% (Consensus)a 12 12 1) We recommend against using systemic glucocorticoids for children with COVID-19 routinely (1C)
2) We suggest a low dose and a short duration for severe COVID-19 children only when over inflammatory reaction or in the context of clinical trials. (2D)
100% (Consensus)
93% (Consensus)
11 13
CQ7 We recommend against the use of intravenous immunoglobulin (IVIG) in the treatment of children with severe COVID-19. (1B) 88% (Consensus) 2 2 We recommend against using intravenous immunoglobulin (IVIG) for children with severe COVID-19. (1B) NA 6 6
CQ8 We propose the following forms of supportive care for children with severe COVID-19:
1) ensuring sufficient number of adequate medical staff in ICUs;
2) systematically monitoring and recording vital signs;
3) using supportive care of the respiratory and cardiovascular symptoms according to clinical needs;
4) providing psychological therapy for children with severe COVID-19
97% (Consensus)
100% (Consensus)
100% (Consensus)
88% (Consensus)
9 9 We propose the following forms of supportive care for children with severe COVID-19:
1) ensuring sufficient number of adequate medical staff in ICUs;
2) systematically monitoring and recording vital signs;
3) using supportive care of the respiratory and cardiovascular symptoms according to clinical needs;
4) providing psychological interventions
NA 5 5
CQ9 We do not recommend interrupting breastfeeding except for mothers with severe COVID-19 72% (Consensus) 15 17 We recommend against mothers interrupting breastfeeding. (2C) NA 7 7
CQ10 1)We recommend parents to arrange national and international travel with caution during the SARS-CoV-2 epidemic, and follow the epidemiological situation in their travel destination(1D);
2)We recommend parents to obtain information from print media, authorities and official agencies rather than social media(1D)
3)We recommend parents to provide their children with suitable health education to improve the awareness on infectious diseases and teach their children not to discriminate people from areas affected by the epidemic 1D)
94% (Consensus) 8 14 We recommend parents to obtain information regularly from academic and official resources rather than social media. (1D) NA 2 2
  1. CQ Clinical Question, NA Not Applicable
  2. aAlthough Recommendation 6 consensus was reached in the first round, a second consensus was conducted in the second round as most experts suggested that it be split into two articles for presentation; The downward slash marks the modified content