PONE-D-23-33238Younger and Rural Children are More Likely to be Hospitalized for SARS-CoV-2 Infections.PLOS ONE

Dear Dr. Kennedy,

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The Translational Research Institute (NIH/NCATS UL1TR003107)"

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Additional Editor Comments:

The paper presents a useful study on the factors contributing to pediatric cases of SARS-CoV-2.

The authors are encouraged to submit a minor revision that addresses the reviewer’s comments related to missing explanations on the dataset and improvements to the presentation of the results.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study performed a comprehensive retrospective review at a single center and using the Pediatric Hospital Information System (PHIS) on pediatric cases of SARS-CoV-2 infection leading to hospitalization. This study delineated demographic information and odds ratio for hospitalization, with different subgroup analyses (such as age group, race and gender). Overall, these comprehensive review and data analysis were performed well. There are some minor suggestions that can further improve the manuscript prior to publication.

1. In line 41, the manuscript stated the children that presented to ACH between March 1, 2020, and April 28, 2022 were included. However, in line 71, the start date of pre-Delta period is stated as May 27, 2020. Furthermore, in line 109, the manuscript stated that cases identified were between May 28, 2020 and April 28, 2022. The authors should explain the reasons of differences in the start dates of case identification.

2. Section ‘Data preprocessing’, a cut-off of 30 days was used to differentiate initial and second infection. It is necessary to explain, preferably with reference(s), to support the use of such a cut-off.

3. In line 118, please consider the change of ‘One hundred and thirty’ to ‘130’ as Arabic numbers were used to describe number of patients in line 117 and 119, and 130 should be a large enough number to be used as an Arabic number to start the sentence.

4. For reference no. 26, it would be consistent to change ‘Accessed 8/2023’ to ‘Accessed August 2023’ as the same style as references no. 1 and 15.

5. In table 2, the p-value for univariate analyses in the gender part is 0.0398, which should be considered significant according to the statistical analysis stated. However, the p-value was not bolded. Was this because the significance was adjusted for multiple comparisons? Please explain.

6. Figure 2 can be improved by explaining the x-axis and scale in the figure legend.

7. "Sex" is considered to be male/female as determined at birth, whereas gender is the male/female by preference and chosen. For this cohort, the use of "sex" seems more applicable. Additionally, line 58 states the PHIS Database uses "sex" as well. Therefore, this seems to be a more applicable term for this study. If indeed this is the case, please change throughout the manuscript.

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Reviewer #1: Yes: Jaime S Rosa Duque

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Younger and Rural Children are More Likely to be Hospitalized for SARS-CoV-2 Infections.

PONE-D-23-33238R1

Dear Dr. Kennedy,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Satyaki Roy, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study contributes more data to the literature on SARS-CoV-2 infection leading to hospitalization using the Pediatric Hospital Information System. The authors have addressed the prior comments adequately.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Jaime S Rosa Duque

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