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Clinical practice guidelines in multisystem inflammatory syndrome (MIS-C) related to COVID-19: a critical review and
Alanood S Algarni1, Njoud M Alamri2, Noor Z Khayat2
1Department of Pharmacology and Toxicology, Faculty of Pharmacy, Pharmacy Collage, Umm Al-Qura University, Makkah, 21955, Saudi Arabia. aagarni@uqu.edu.sa.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is a serious condition linked to COVID-19. This study unifies clinical guidelines for better MIS-C symptom management and reduced mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Rheumatology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe condition linked to COVID-19, affecting multiple organs.
- MIS-C presents with diverse symptoms including cardiac, renal, respiratory, and neurological issues, requiring prompt intervention.
- Existing clinical guidelines for MIS-C vary, necessitating a consolidated approach for effective management.
Purpose of the Study:
- To compare and evaluate current MIS-C clinical practice guidelines from major medical organizations.
- To develop a unified guideline for the therapeutic management of MIS-C based on existing evidence.
- To propose an algorithm for managing MIS-C disorders, considering diverse guideline recommendations.
Main Methods:
- A systematic review and cross-comparison of five prominent MIS-C clinical practice guidelines.
- Separate assessment of compiled literature by authors.
- Development of a proposed algorithm for managing MIS-C based on guideline synthesis.
Main Results:
- Unified features of MIS-C patients identified, aiding symptom management and mortality reduction.
- Recommendations for pharmacological treatment of MIS-C symptoms formulated through cross-guideline comparison.
- A unified guideline for therapeutic management of MIS-C was proposed.
Conclusions:
- The study provides a unified guideline for MIS-C management based on current evidence.
- The proposed guideline aims to maintain suitable clinical standards within the Saudi Arabian Ministry of Health.
- Further research implications and interpretation of results within broader evidence are discussed.
Background:
Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that develops from and is linked to coronavirus disease 2019. MIS-C is considered a multi-organ dysfunction involving cardiac, renal, respiratory, hematologic, gastrointestinal and neurological symptoms and groups of signs and symptoms such as rash or bilateral non-purulent conjunctivitis, hypotension or shock and acute gastrointestinal problems, which require immediate therapeutic intervention to prevent the aggravation of the patient's health condition. MIS-C is relatively new in the field of evidence-based medicine; however, there are several clinical guidelines for good clinical practice. For every disorder, the guidelines have different suggestions. Hence, based on the current status of the evidence, recommendations have been combined to form a unified guideline for therapeutic management.
Methods:
This paper compares and evaluates the current MIS-C-specific clinical practice guidelines (namely, American Academy of Pediatrics, American College of Rheumatology, Helen DeVos Children's Hospital Foundation, Children's Hospital of The King's Daughters, and the Infectious Diseases Society of America). The compiled literature was then assessed by the authors separately, and an algorithm was proposed for each disorder, taking into consideration the various guidelines proposed for the management of the disorder.
Results:
The features of MIS-C patients are unified; this is very helpful in managing its symptoms and decreasing mortality rates. In addition, recommendations for pharmacological treatment for MIS-C symptoms are formulated after cross-comparison across five different guidelines.
Conclusions:
This study provides a general interpretation of the results in the context of other evidence and implications for future research. It proposes a unified guideline based on the current evidence, with the best potential to maintain suitable clinical standards in the Saudi Arabian Ministry of Health.
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