Rationale: The e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak peaked in September 2019, yet hospitalization of adolescents for EVALI has continued. We describe the clinical features and short-term pulmonary function outcomes of 36 adolescents hospitalized for EVALI at a large, tertiary-care, university-affiliated children's hospital, including 17 who were treated during the COVID-19 pandemic.Methods: An electronic health record review of adolescents hospitalized at our institution with confirmed or suspected EVALI from December 2018 to December 2020 was conducted. Descriptive statistics were used to characterize sociodemographic data, clinical course, imaging, laboratory results and response to treatment. The Mann-Whitney U test was used to compare pulmonary function test (PFT) results pre- to post- glucocorticoid administration, and also postglucocorticoid to post-discharge.Results: The mean age was 16.3 years;33% were female and 56% were Hispanic. All patients had constitutional symptoms;fever (92%) was the most common. All patients had respiratory (83%) or gastrointestinal (89%) symptoms upon presentation;72% had both. Vaping tetrahydrocannabinol (THC) was reported in 97% and nicotine in 53%. Patients underwent workup or treatment for asthma, typical and atypical pneumonia, appendicitis, sepsis, pulmonary embolism, and respiratory viruses including SARS-CoV-2 before EVALI diagnosis. Urinary THC metabolite was present in 100% of patients tested. Bilateral ground-glass opacities were noted on chest computed tomography (CT) in 97%. Maximal respiratory support of nasal cannula, bi-level positive airway pressure, intubation with mechanical ventilation, or veno-venous extracorporeal membrane oxygenation characterized 18, 4, 4 and 1 patients respectively. SARS-CoV-2 polymerase chain reaction (PCR) testing was positive in 1 out of 17 patients tested;this patient required intensive care and was treated with remdesivir and dexamethasone. Intravenous antibiotics were administered to 69% of patients without subsequent clinical improvement. In contrast, 94% of patients treated with systemic glucocorticoids improved within 24 hours. Median length of hospital stay was 7 days. No patients died. Follow-up CT scan done 1-4 months post-discharge in 5 patients showed complete resolution of ground-glass opacities. A statistically significant improvement (P&lt;0.05) in all pulmonary function measures was observed post-glucocorticoid to post discharge while spirometry and six-minute walk distance also improved pre-and post-glucocorticoid (figure1). Conclusions: Although COVID-19 infection was suspected in many adolescents with EVALI owing to symptom profile overlap, positive SARS-CoV-2 PCR was rare. Imaging findings, clinical symptoms and PFTs improved after glucocorticoid treatment for EVALI.
Clinical presentation, management and short-term outcomes in adolescents hospitalized with electronic cigarette, or vaping, product-use associated lung injury (evali)