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

Matthew L. Dove, Preeti Jaggi, Michael Kelleman, Mayssa Abuali, Jocelyn Y. Ang, Wassim Ballan, Sanmit K. Basu, M. Jay Campbell, Sathish M. Chikkabyrappa, Nadine F. Choueiter, Katharine N. Clouser, Daniel Corwin, Amy Edwards, Shira J. Gertz, Rod Ghassemzadeh, Rima J. Jarrah, Sophie E. Katz, Stacie M. Knutson, Joseph D. Kuebler, Jennifer LighterChristine Mikesell, Kanokporn Mongkolrattanothai, Ted Morton, Natasha A. Nakra, Rosemary Olivero, Christina M. Osborne, Laurie E. Panesar, Sarah Parsons, Rupal M. Patel, Jennifer Schuette, Deepika Thacker, Adriana H. Tremoulet, Navjyot K. Vidwan, Matthew E. Oster

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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 US. Study design: 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. 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 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)33-40
Number of pages8
JournalJournal of Pediatrics
StatePublished - Feb 1 2021

Bibliographical note

Funding Information:
We thank the additional individuals who contributed data to this survey, including Eva Cheung, MD (NewYork-Presbyterian Morgan Stanley Children's Hospital of Columbia Irving Medical Center); Lauren Henderson, MD, MMSc (Boston Children's Hospital); Whitnee J. Hogan, MD (UCSF Benioff Children's Hospital); Sean Lang, MD (Cincinnati Children's Hospital Medical Center); Jennifer Schuster, MD, MSCI (Children's Mercy Kansas City); Renata Shih, MD (Congenital Heart Center, University of Florida); Dongngan T. Truong, MD, MS (University of Utah/Primary Children's Hospital); Rajiv Verma, MD (Children's Hospital of New Jersey); and Justin P. Zachariah, MD, MPH (Texas Children's Hospital, Baylor College of Medicine). We also thank the multidisciplinary teams that helped to create MIS-C protocols at the children's hospitals in this study, without whose collaborative efforts this study would not have been possible.

Publisher Copyright:
© 2020 Elsevier Inc.

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