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Clinical Presentation and Diagnostic Patterns of Multisystem Inflammatory Syndrome in Children in a Pediatric

Alexander B Rosiejka1, Danny G Thomas2, Mark Nimmer2

  • 1Medical College of Wisconsin, Milwaukee, Wisconsin, arosiejka@mcw.edu.

WMJ : Official Publication of the State Medical Society of Wisconsin
|June 8, 2026
PubMed

Insights

Multisystem inflammatory syndrome in children (MIS-C) diagnosis is challenging. Older children with cardiac and gastrointestinal symptoms are more likely to have MIS-C, while non-COVID-19 viral tests suggest alternative diagnoses.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Critical Care

Background:

  • Multisystem inflammatory syndrome in children (MIS-C) is a severe postinfectious complication of COVID-19.
  • Diagnosis of MIS-C is challenging due to overlapping symptoms with other pediatric illnesses.
  • Effective diagnostic strategies are needed for timely MIS-C identification in emergency departments.

Purpose of the Study:

  • To describe emergency department (ED) evaluations for suspected MIS-C in children.
  • To identify clinical and laboratory factors that differentiate MIS-C from alternative diagnoses.
  • To aid clinicians in risk stratification and diagnostic decision-making for suspected MIS-C.

Main Methods:

  • Retrospective study of children evaluated for MIS-C in a pediatric ED from July 2020 to December 2022.
  • Comparison of clinical and laboratory characteristics between MIS-C and alternative diagnoses.
  • Logistic regression analysis to identify factors associated with MIS-C.

Main Results:

  • Of 792 children evaluated, 86 (11%) were diagnosed with MIS-C.
  • Children with MIS-C were older (median age 7.4 vs 2.9 years) and had higher odds of cardiac, mucocutaneous, gastrointestinal, and hematologic system involvement.
  • Positive non-COVID-19 viral tests were associated with alternative diagnoses (OR, 0.12).

Conclusions:

  • Specific symptoms aligning with MIS-C criteria increase the likelihood of MIS-C diagnosis.
  • Positive non-COVID-19 viral tests in children evaluated for MIS-C suggest alternative diagnoses.
  • Findings can assist emergency department clinicians in diagnosing MIS-C and stratifying patient risk.
Abstract

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