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Identifying pediatric patients with multisystem inflammatory syndrome in children presenting to a pediatric emergency
Jaclyn N Kline1, Sarah C Isbey1, Nichole L McCollum1
1Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA; George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, USA.
Insights
Elevated C-reactive protein (CRP) and low absolute lymphocyte count (ALC) effectively identify Multisystem Inflammatory Syndrome in Children (MIS-C). This finding aids in early diagnosis of MIS-C in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Immunology
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious condition requiring prompt diagnosis.
- Identifying reliable biomarkers for MIS-C is crucial for timely intervention.
Purpose of the Study:
- To compare clinical and laboratory features of confirmed MIS-C cases with those evaluated for MIS-C.
- To determine the diagnostic utility of specific laboratory markers for MIS-C in a pediatric emergency department setting.
Main Methods:
- Retrospective review of medical records for children tested for inflammatory markers.
- Analysis of demographic, laboratory, and clinical presentation data.
- Use of receiver operating curves and logistic regression to assess predictive value of laboratory markers.
Main Results:
- Confirmed MIS-C patients were older and presented with higher fevers.
- Elevated C-reactive protein (CRP) >4.5 mg/dL and absolute lymphocyte count (ALC) <1.5 K/mcL were significantly associated with MIS-C.
- CRP >4.5 mg/dL and ALC <1.5 K/mcL demonstrated 86% sensitivity and 91% specificity for MIS-C identification.
Conclusions:
- Elevated CRP and lymphopenia are highly sensitive and specific indicators for identifying MIS-C in children.
- These laboratory findings can aid in the early and accurate diagnosis of MIS-C in the emergency department.
Objective:
To compare 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).
Methods:
We conducted a retrospective review of the medical record of encounters with testing for inflammatory markers in an urban, tertiary care Pediatric ED from March 1, 2020 to July 31, 2020. We abstracted demographic information, laboratory values, selected medications and diagnoses. We reviewed the record for clinical presentation for the subset of patients admitted to the hospital for suspected MIS-C. We then used receiver operating curves and logistic regression to evaluate the utility of candidate laboratory values to predict MIS-C status.
Results:
We identified 32 patients with confirmed MIS-C and 15 admitted and evaluated for MIS-C but without confirmation of SARS CoV-2 infection. We compared these patients to 267 encounters with screening laboratories for MIS-C. Confirmed MIS-C patients had an older median age, higher median fever on presentation and were predominantly of Hispanic and non-Hispanic Black race/ethnicity. All children with MIS-C had a C-reactive protein (CRP) >4.5 mg/dL, were more likely to have Brain Natriuretic Peptide >400 pg/mL (OR 10.50, 95%CI 4.40-25.04), D-Dimer >3 μg/mL (7.51, [3.18-17.73]), and absolute lymphocyte count (ALC) <1.5 K/mcL (21.42, [7.19-63.76]). We found CRP >4.5 mg/dL and ALC <1.5 K/mcL to be 86% sensitive and 91% specific to identify MIS-C among patients screened in our population.
Conclusions:
We identified that elevated CRP and lymphopenia was 86% sensitive and 91% specific for identification of children with MIS-C.
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