Clinical Manifestations of EVALI in Adolescents Before and During the
Introduction: E-cigarette, or vaping, product use-associated lung injury
(EVALI) results from inhaling the aerosol of e-cigarettes and has
similar clinical features to coronavirus disease 2019 (COVID-19). EVALI
case counts since the declaration of the COVID-19 pandemic is unknown.
Methods: A retrospective electronic health record chart review of
adolescents hospitalized at one institution with EVALI was conducted.
Clinical characteristics and hospital course of patients hospitalized
during the pandemic were compared to those pre-pandemic. Results: The
clinical presentation of adolescents hospitalized prior-to (n=19) and
during the COVID-19 pandemic (n=22) were similar with respect to
constitutional, respiratory, and gastrointestinal symptoms. All patients
hospitalized during the pandemic were tested for COVID-19 at least once.
Only one patient had a positive SARS-CoV-2 RT-PCR test result. 31 out of
39 patients treated with corticosteroids had clinical improvement within
24 hours (79%). Patients hospitalized during the pandemic had a shorter
median length of stay (5 vs 7 days, p<0.01), and were less
often discharged with home oxygen (1 vs 6 patients, p=0.04). Pulmonary
function tests improved pre-to post-corticosteroid treatment and
post-corticosteroid to follow-up. Conclusions: Eliciting a history of
vaping in adolescents presenting with constitutional, respiratory, and
gastrointestinal symptoms is important to identify EVALI cases, which
have continued throughout the COVID-19 pandemic. A shorter length of
stay with less need for mechanical ventilation and home oxygen in
adolescents hospitalized during the pandemic may reflect increased
familiarity with EVALI characteristics. Corticosteroids led to clinical
and pulmonary function improvement.