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

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).

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.

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.

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.