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

• Published in: The Journal of pediatrics Vol. 229; pp. 33 - 40
• Main Authors: Dove, Matthew L., Jaggi, Preeti, Kelleman, Michael, Abuali, Mayssa, Ang, Jocelyn Y., Ballan, Wassim, Basu, Sanmit K., Campbell, M. Jay, Chikkabyrappa, Sathish M., Choueiter, Nadine F., Clouser, Katharine N., Corwin, Daniel, Edwards, Amy, Gertz, Shira J., Ghassemzadeh, Rod, Jarrah, Rima J., Katz, Sophie E., Knutson, Stacie M., Kuebler, Joseph D., Lighter, Jennifer, Mikesell, Christine, Mongkolrattanothai, Kanokporn, Morton, Ted, Nakra, Natasha A., Olivero, Rosemary, Osborne, Christina M., Panesar, Laurie E., Parsons, Sarah, Patel, Rupal M., Schuette, Jennifer, Thacker, Deepika, Tremoulet, Adriana H., Vidwan, Navjyot K., Oster, Matthew E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2021
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticoagulants - therapeutic use; Antirheumatic Agents - therapeutic use; Aspirin - therapeutic use; Child; Clinical Protocols; COVID-19 - diagnosis; COVID-19 - therapy; Cross-Sectional Studies; Glucocorticoids - therapeutic use; Heparin - therapeutic use; Hospitals; Humans; Immunoglobulins, Intravenous; Interleukin 1 Receptor Antagonist Protein - therapeutic use; Original; Practice Patterns, Physicians' - statistics & numerical data; Surveys and Questionnaires; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - therapy; United States - epidemiology; Vasoconstrictor Agents - therapeutic use; United States; COVID-19; IVIG; MIS-C; SARS-CoV-2; MRI
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2020.10.026

To describe the similarities and differences in the evaluation and treatment of multisystem inflammatory syndrome in children (MIS-C) at hospitals in the US.
We conducted a cross-sectional survey from June 16 to July 16, 2020, of US 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.
In all, 40 centers of varying size and experience with MIS-C participated in this protocol survey. Overall, 21 of 40 centers required only 1 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 frequently were 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.
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.