Multisystem Inflammatory Syndrome in Children: Survey of Protocols for Early Hospital Evaluation and Management

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Objective

To describe the similarities and differences in the evaluation and treatment of multisystem inflammatory syndrome in children (MIS-C) at hospitals in the United States.

Study design

We conducted a cross-sectional survey from June 16 to July 16, 2020 of U.S. children’s hospitals regarding protocols for management of patients with MIS-C. Elements included characteristics of the hospital, clinical definition of MIS-C, evaluation, treatment, and follow up. We summarized key findings and compared results from centers in which >5 patients had been treated vs those in which <5 patients had been treated.

Results

In all, 40 centers of varying size and experience with MIS-C participated in this protocol survey. Overall 21 of 40 centers required only one day of fever for MIS-C to be considered. In the evaluation of patients, there was often a tiered approach. Intravenous immunoglobulin was the most widely recommended medication to treat MIS-C (98% of centers). Corticosteroids were listed in 93% of protocols primarily for moderate or severe cases. Aspirin was commonly recommended for mild cases, whereas heparin or low molecular weight heparin were to be used primarily in severe cases. In severe cases, anakinra and vasopressors were frequently recommended; 39 of 40 centers recommended follow up with cardiology. There were similar findings between centers in which >5 patients vs. <5 patients had been managed. Supplemental materials containing hospital protocols are provided.

Conclusion

There are many similarities yet key differences between hospital protocols for MIS-C. These findings can help healthcare providers learn from others regarding options for managing MIS-C.

Abbreviations:

AHA (American Heart Association), CDC (Centers for Disease Control and Prevention), CHOA (Children’s Healthcare of Atlanta), COVID-19 (Coronavirus Disease 2019), IVIG (intravenous immunoglobulin), MIS-C (Multisystem Inflammatory Syndrome in Children), MRI (magnetic resonance imaging), PCR (polymerase chain reaction), PIMS-TS (Pediatric Multisystem Inflammatory Syndrome – Temporally Associated with), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), REDCap (Research Electronic Data Capture)

In April 2020, physicians in the United Kingdom and France identified an outbreak of children admitted to the pediatric intensive care unit with a hyperinflammatory condition characterized by fever, cardiovascular shock, and suspected SARS-CoV-2 infection: pediatric multisystem inflammatory syndrome – temporally associated with SARS-CoV-2 (PIMS-TS).(

  • Riphagen S.
  • Gomez X.
  • Gonzalez-Martinez C.
  • Wilkinson N.
  • Theocharis P.
Hyperinflammatory shock in children during COVID-19 pandemic.