Assistant Professor, Pediatric Rheumatology University of Utah University of Utah Health Salt Lake City, Utah, United States
Background: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is characterized by fever, elevated inflammatory markers, and involvement of ≥2 organ systems. The spectrum of presenting symptoms and lab abnormalities often overlap with other illnesses, making diagnosis challenging. In the Intermountain West, many children live hours away from dedicated pediatric facilities, leading to delays in care that could impact patient outcomes. Critically ill children in this region are frequently referred to Primary Children’s Hospital (PCH), where a multidisciplinary team developed guidelines to standardize the evaluation and treatment of MIS-C.
Objective: To characterize the presentation of MIS-C and to determine if healthcare setting at presentation affects time to diagnosis and hospital outcomes.
Design/Methods: Retrospective chart review of MIS-C patients <21 years of age hospitalized at PCH between 4/2020 and 12/2020. Descriptive statistics were used. Wilcoxon rank sum was used to compare outcomes in patients with initial presentation in an ambulatory vs. emergency department.
Results: We identified 34 patients with a median age of 7.9 years (0.7-17.5) (Table 1). The most common initial manifestations were fever, mucocutaneous symptoms, and gastrointestinal symptoms (Table 2). At least 3 Kawasaki Disease criteria were seen in 65%. The most common elevated labs at presentation were D-Dimer, CRP, ferritin, procalcitonin, serum IL-6. Fifty-three percent of patients initially presented to an outpatient clinic.. Median days from symptom onset to admission was longer if patients first presented to an outpatient setting vs. an emergency department (6 vs. 4 days, p=0.03). PICU admission occurred in 71% of patients with a median stay of 2 days (range 1-10). Median length of hospitalization was 6 days (3-16). There was no significant difference on length of stay or need for PICU based on presentation setting. There was 1 readmission within 30 days for aseptic meningitis. No patients died. Conclusion(s): While days of symptoms prior to admission were higher in MIS-C patients first presenting to an outpatient setting, it is unclear if this affects outcomes or if it reflects severity of illness in those presenting to emergency departments. Readmission is uncommon. This study highlights the varied presentations of MIS-C and a potential need for education of primary care and urgent care providers as they are often the first point of healthcare for children with symptoms of MIS-C.
Table 1. Demographic information for children diagnosed with MIS-C.
Table 2. MIS-C Clinical Manifestations at Presentation.
Table 3. MIS-C Laboratory Criteria at Presentation.
Authors/Institutions: Erin B. Treemarcki, University of Utah Health, Salt Lake City, Utah, United States; Elizabeth Vukin, University of Utah Health, Salt Lake City, Utah, United States; Dongngan T. Truong, University of Utah Health, Salt Lake City, Utah, United States; Aimee Hersh, University of Utah Health, Salt Lake City, Utah, United States; CJ J. inman, University of Utah Health, Salt Lake City, Utah, United States; Sara M. Stern, University of Utah Health, Salt Lake City, Utah, United States; Karen E. James, University of Utah Health, Salt Lake City, Utah, United States
