Figure 1. Directed Acyclic Graph for Association of Steroids With Outcomes for Children Hospitalized With COVID-19 Without Multisystem Inflammatory Syndrome in Children.

Letters represent modified directed acyclic graph symbols. L represents the condition, A the treatment, and Y the effect. R represents a proxy confounder for C. B represents the variables listed below. A box around the letter represents blocking the backdoor path. A and Y represent reality and A* and Y* measurements in the study. The difference represents bias. Selection bias: factors that influence patients getting steroids also independently predict hospital length of stay (LOS). Information bias: hospital LOS may not be the best indicator of recovery.

^aInflammation was indicated by the number of inflammatory mediators with abnormal values on admission.

^bDisease severity was measured by a composite of World Health Organization ordinal scale score of 4 or higher at admission or intensive care unit admission within 2 days of hospital admission.