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Characteristics and Outcomes of Critically Ill Children With Multisystem Inflammatory Syndrome
Kellie Snooks1, Matthew C Scanlon1, Kenneth E Remy2
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Insights
Multisystem inflammatory syndrome in children (MIS-C) affected 0.9% of pediatric intensive care unit admissions. Despite a MIS-C surge in early 2021, outcomes improved, indicating viral strain was not the primary driver.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition linked to SARS-CoV-2.
- Understanding MIS-C prevalence and outcomes is crucial for pediatric critical care.
Purpose of the Study:
- To determine the prevalence of MIS-C in pediatric intensive care units (PICUs).
- To evaluate the impact of different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains on MIS-C outcomes.
Main Methods:
- Retrospective cohort study utilizing the Virtual Pediatric Systems Database.
- Analysis of 145,580 PICU admissions across 115 hospitals from January 2020 to June 2021.
- Examined MIS-C cases, length of stay, mechanical ventilation rates, and mortality, correlating with SARS-CoV-2 strain data.
Main Results:
- MIS-C accounted for 0.9% (1,338 cases) of PICU admissions, peaking in Q1 2021.
- Median PICU length of stay was 2.7 days, hospital length of stay was 6.6 days.
- 15.2% required mechanical ventilation; overall mortality was low (11 deaths).
- Significant decreases in length of stay and ventilation frequency observed from Q4 2020 onwards.
- PICU LOS was longer for patients admitted from general care or step-down units compared to direct ED admissions.
Conclusions:
- MIS-C represented a substantial burden of critical illness in children.
- While MIS-C cases surged with new SARS-CoV-2 strains, outcomes improved independently of strain changes starting in late 2020.
- Findings suggest factors other than viral strain predominantly influence MIS-C outcomes.
Objectives:
To characterize the prevalence of pediatric critical illness from multisystem inflammatory syndrome in children (MIS-C) and to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain on outcomes.
Design:
Retrospective cohort study.
Setting:
Database evaluation using the Virtual Pediatric Systems Database.
Patients:
All children with MIS-C admitted to the PICU in 115 contributing hospitals between January 1, 2020, and June 30, 2021.
Measurements And Main Results:
Of the 145,580 children admitted to the PICU during the study period, 1,338 children (0.9%) were admitted with MIS-C with the largest numbers of children admitted in quarter 1 (Q1) of 2021 ( n = 626). The original SARS-CoV-2 viral strain and the D614G Strain were the predominant strains through 2020, with Alpha B.1.1.7 predominating in Q1 and quarter 2 (Q2) of 2021. Overall, the median PICU length of stay (LOS) was 2.7 days (25-75% interquartile range [IQR], 1.6-4.7 d) with a median hospital LOS of 6.6 days (25-75% IQR, 4.7-9.3 d); 15.2% received mechanical ventilation with a median duration of mechanical ventilation of 3.1 days (25-75% IQR, 1.9-5.8 d), and there were 11 hospital deaths. During the study period, there was a significant decrease in the median PICU and hospital LOS and a decrease in the frequency of mechanical ventilation, with the most significant decrease occurring between quarter 3 and quarter 4 (Q4) of 2020. Children admitted to a PICU from the general care floor or from another ICU/step-down unit had longer PICU LOS than those admitted directly from an emergency department.
Conclusions:
Overall mortality from MIS-C was low, but the disease burden was high. There was a peak in MIS-C cases during Q1 of 2021, following a shift in viral strains in Q1 of 2021. However, an improvement in MIS-C outcomes starting in Q4 of 2020 suggests that viral strain was not the driving factor for outcomes in this population.
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