A guide to identifying pediatric patients with multisystem inflammatory syndrome in those presenting to a pediatric emergency department

Kline JN et al., in their study, compared the clinical and laboratory features of children with Multisystem Inflammatory Syndrome in Children (MIS-C) to those evaluated for MIS-C in the Emergency Department (ED).

They conducted a retrospective review of the medical record of patients with testing for inflammatory markers from March 1, 2020, to July 31, 2020. They abstracted demographic information, laboratory values, selected medications, and diagnoses; and also reviewed the record for clinical presentation for the subset of patients admitted to the hospital for suspected MIS-C. They then evaluated the utility of candidate laboratory values to predict MIS-C status.

Kline JN et al. identified 32 patients with confirmed MIS-C, and 15 admitted and evaluated for MIS-C but without confirmation of SARS CoV-2 infection. They compared these patients to 267 encounters with screening laboratories for MIS-C. 

The researchers found that the confirmed MIS-C patients had older median age, higher median fever on presentation, and were predominantly of Hispanic and non-Hispanic Black race/ethnicity. All children with MIS-C held a C-reactive protein (CRP) >4.5 mg/dL, were more likely to have Brain Natriuretic Peptide >400 pg/mL, D-Dimer >3 μg/mL, and absolute lymphocyte count (ALC) <1.5 K/mcL. They also found CRP >4.5 mg/dL and ALC <1.5 K/mcL to be 86% sensitive and 91% specific in identifying MIS-C among patients in the screened population.

In the present study, the researchers identified that elevated CRP and lymphopenia were 86% sensitive and 91% specific for identifying children with MIS-C. These results can be employed and investigated in other populations as well.

Kline JN, Isbey SC, McCollum NL, et al. Identifying pediatric patients with the multisystem inflammatory syndrome in children presenting to a pediatric emergency department. The American Journal of Emergency Medicine. 2022;51:69-75. https://doi.org/10.1016/j.ajem.2021.10.011.

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