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Cardiac Point-of-Care Ultrasound Findings in Multisystem Inflammatory Syndrome in Children in the Pediatric Emergency
Inbal Kestenbom1, Eric Scheier2,3, Bat-Hen Annie Daviko4
1Department of Pediatric Emergency, Soroka University Medical Center, Beer Sheva.
Insights
Point-of-care ultrasound (POCUS) effectively evaluates cardiac function in children with multisystem inflammatory syndrome (MIS-C) in the pediatric emergency department (PED). Sixteen percent of MIS-C patients showed decreased cardiac function on POCUS, highlighting its utility.
Area of Science:
- Pediatric Cardiology
- Emergency Medicine
- Infectious Diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition often involving cardiac complications.
- Cardiac point-of-care ultrasound (POCUS) offers rapid bedside assessment in pediatric emergency departments (PEDs).
- Limited data exists on cardiac POCUS findings specifically in pediatric MIS-C patients presenting to the PED.
Purpose of the Study:
- To describe the cardiac POCUS findings in children diagnosed with MIS-C in the PED.
- To assess the applicability of cardiac POCUS for evaluating MIS-C patients in an emergency setting.
Main Methods:
- A multicenter, retrospective cohort study was conducted across 6 PEDs in Israel.
- Included were 32 patients diagnosed with MIS-C who underwent cardiac POCUS between February 2021 and March 2022.
- POCUS clips were reviewed by a pediatric emergency medicine POCUS expert.
Main Results:
- Of 32 MIS-C patients, 84% had normal cardiac function, while 16% exhibited decreased cardiac function on POCUS.
- No patients presented with pathological cardiac effusion; 3 had plethoric inferior vena cava.
- Patient demographics included a median age of 8 years, with 63% males; 47% required pediatric intensive care unit admission.
Conclusions:
- Cardiac POCUS is a practical tool for evaluating MIS-C patients in the PED.
- The study identified decreased cardiac function in 16% of MIS-C patients upon PED presentation via POCUS.
- Further research is warranted to determine the impact of POCUS on MIS-C patient management in the PED.
Objectives:
Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening condition associated with cardiac involvement. Cardiac point-of-care ultrasound (POCUS) can be performed at the bedside in the pediatric emergency department (PED) to identify cardiac pathology. There is limited data on cardiac POCUS findings in children with MIS-C in the PED. The main outcome objective of our study was to describe the cardiac POCUS findings in MIS-C patients in the PED.
Methods:
This is a multicenter, retrospective, cohort study between February 15, 2021 and March 31, 2022, during the alpha, delta, and omicron severe acute respiratory syndrome coronavirus 2 waves in 6 PEDs in Israel. We included patients diagnosed with MIS-C who received a cardiac POCUS examination in the PED. All POCUS clips were analyzed by a PED POCUS expert.
Results:
We included 32 MIS-C patients who underwent cardiac POCUS during the study period. The median age was 8 years (interquartile range = 6 to 10 y), and 20 (63%) were males. The median time from onset of symptoms upon PED visit was 5 days (interquartile range = 4 to 5 d). Overall, 27 patients (84%) were diagnosed with normal cardiac function and 5 patients with decreased cardiac function (16%). No patients were diagnosed with pathologic cardiac effusion. Three patients were diagnosed with plethoric inferior vena cava. Among the patients, 17 (53%) were admitted to the pediatric wards and 15 (47%) to the pediatric intensive care unit. There was no mortality.
Conclusion:
Cardiac POCUS by PEM physicians is an applicable tool for the evaluation of MIS-C patients in the PED. In our study, 16% of MIS-C patients who underwent POCUS had decreased cardiac function per POCUS on their PED presentation. Future studies are needed to evaluate the impact of cardiac POCUS in the PED of patients with MIS-C.
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