Multisystem Inflammatory Syndrome in Children: Survey of Protocols for Early Hospital Evaluation and Management
Matthew L Dove1, Preeti Jaggi2, Michael Kelleman1
1Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA.
Insights
Multisystem inflammatory syndrome in children (MIS-C) treatment protocols show similarities and differences across US hospitals. These findings aid healthcare providers in managing MIS-C by sharing best practices.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition.
- Understanding current hospital protocols for MIS-C is crucial for effective patient management.
Purpose of the Study:
- To delineate the similarities and disparities in the evaluation and treatment strategies for MIS-C among US hospitals.
- To identify common practices and variations in MIS-C management protocols.
Main Methods:
- A cross-sectional survey was administered to US children's hospitals from June 16 to July 16, 2020.
- The survey collected data on hospital characteristics, MIS-C definitions, evaluation, treatment, and follow-up protocols.
- Findings were compared between centers with >5 treated patients and those with ≤5 treated patients.
Main Results:
- 40 centers participated, revealing variations in fever duration criteria for MIS-C diagnosis.
- Intravenous immunoglobulin (98%) and corticosteroids (93%) were widely recommended treatments.
- Aspirin for mild cases and heparin/low molecular weight heparin for severe cases were common; anakinra and vasopressors were used in severe cases.
- Cardiology follow-up was recommended by 39 of 40 centers.
Conclusions:
- Significant similarities and key differences exist in US hospital protocols for managing MIS-C.
- Sharing these findings can enhance healthcare providers' understanding and options for MIS-C treatment.
- Standardization of care may be beneficial, while acknowledging the need for flexibility based on case severity.
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.
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