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Predicting Intensive Care Utilization for Patients With MIS-C in the Emergency Department
Erin Aldag1, Allayne Stephans2, Doug Lorenz3
1Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT.
Insights
Early identification of severe multisystem inflammatory syndrome in children (MIS-C) is crucial. Presenting signs and laboratory results in the emergency department can predict intensive care needs, aiding timely interventions for children with MIS-C.
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.
Objectives:
Patients with multisystem inflammatory syndrome in children (MIS-C) frequently require intensive care. Few studies have evaluated presenting signs and symptoms suggesting severe disease. We aimed to identify risk factors for intensive care utilization in patients with MIS-C on presentation to the emergency department (ED).
Methods:
We conducted a multicenter retrospective cohort analysis among patients aged 6 months to 18 years diagnosed with MIS-C at 5 academic hospitals in the United States from 2020 to 2022. Demographics, initial examination, laboratory results, and outcomes were obtained by electronic health record review. Adjusted odds ratios were derived to measure the association between covariables and intensive care needs. An exploratory analysis was performed among patients transferred from the medical floor to the intensive care unit to identify factors indicating delayed decompensation.
Results:
Among 432 patients with MIS-C, 190 required intensive care. Factors in the ED associated with increased odds of intensive care utilization on multivariable analysis were older age, delayed capillary refill, hypotension, tachypnea, hypoxemia, elevated prothrombin time, B-type natriuretic peptide, procalcitonin, and alanine transaminase. The full multivariable model exhibited a raw area under the curve of 0.92. In an exploratory analysis among 40/242 patients admitted to the medical floor but subsequently required transfer to the intensive care unit, older age, higher maximum ED temperature, severe tachycardia, elevated d -dimer, absolute neutrophil count, and C-reactive protein were associated with pediatric intensive care unit transfer in univariate analysis.
Conclusions:
Presenting signs, symptoms, and laboratory findings may be utilized in the ED to identify patients with MIS-C who have increased odds of initial intensive care utilization and potential later clinical deterioration. These data may help ED physicians identify patients who would benefit from more intensive monitoring or transfer to a tertiary care facility, where appropriate.
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