Predicting Intensive Care Utilization for Patients With MIS-C in the Emergency Department.

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Inflammatory disorders

Background:

• Multisystem inflammatory syndrome in children (MIS-C) often requires intensive care.
• Identifying early indicators of severe MIS-C is essential for prompt management.

Purpose of the Study:

• To identify risk factors for intensive care unit (ICU) utilization in pediatric patients diagnosed with MIS-C upon emergency department (ED) presentation.
• To explore factors associated with delayed decompensation in MIS-C patients initially admitted to the medical floor.

Main Methods:

• Multicenter retrospective cohort analysis of 432 MIS-C patients (aged 6 months to 18 years) from 2020-2022.
• Electronic health record review for demographics, clinical signs, and laboratory results.
• Multivariable analysis to determine associations between presenting factors and ICU needs.

Main Results:

• 190 of 432 MIS-C patients required ICU admission.
• ED factors associated with increased ICU odds included older age, delayed capillary refill, hypotension, tachypnea, hypoxemia, elevated prothrombin time, BNP, procalcitonin, and ALT.
• Exploratory analysis identified older age, fever, tachycardia, elevated D-dimer, ANC, and CRP as predictors of ICU transfer from the medical floor.

Conclusions:

• Presenting clinical and laboratory findings in the ED can identify MIS-C patients at higher risk for initial ICU admission.
• These indicators may also predict later clinical deterioration, guiding decisions for intensive monitoring or transfer to specialized care centers.