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Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic.
Pediatr Emerg Care. 2020 Nov; 36(11):554-558.PE

Abstract

OBJECTIVE

The aim of the study was to compare presenting clinical and laboratory features among children meeting the surveillance definition for multisystem inflammatory syndrome in children (MIS-C) across a range of illness severities.

METHODS

This is a retrospective single-center study of patients younger than 21 years presenting between March 1 and May 15, 2020. Included patients met the Centers for Disease Control and Prevention criteria for MIS-C (inflammation, fever, involvement of 2 organ systems, lack of alternative diagnoses). We defined 3 subgroups by clinical outcomes: (1) critical illness requiring intensive care interventions; (2) patients meeting Kawasaki disease (KD) criteria but not requiring critical care; and (3) mild illness not meeting either criteria. A comparator cohort included patients with KD at our institution during the same time frame in 2019.

RESULTS

Thirty-three patients were included (5, critical; 8, 2020 KD; 20, mild). The median age for the critical group was 10.9 years (2.7 for 2020 KD; 6.0 for mild, P = 0.033). The critical group had lower median absolute lymphocyte count (850 vs 3005 vs 2940/uL, P = 0.005), platelets (150 vs 361 vs 252 k/uL, P = 0.005), and sodium (129 vs 136 vs 136 mmol/L, P = 0.002), and higher creatinine (0.7 vs 0.2 vs 0.3 mg/dL, P = 0.002). In the critical group, 60% required vasoactive medications, and 40% required mechanical ventilation. Clinical and laboratories features were similar between the 2020 and 2019 KD groups.

CONCLUSIONS

We describe 3 groups with inflammatory syndromes during the SARS-CoV-2 pandemic. The initial profile of lymphopenia, thrombocytopenia, hyponatremia, and abnormal creatinine may help distinguish critically ill MIS-C patients from classic/atypical KD or more benign acute inflammation.

Authors+Show Affiliations

From the Divisions of Emergency Medicine.From the Divisions of Emergency Medicine.No affiliation info availableInfectious Diseases.From the Divisions of Emergency Medicine.Infectious Diseases.Rheumatology.Oncology.Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA.Oncology.From the Divisions of Emergency Medicine.From the Divisions of Emergency Medicine.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32970023

Citation

Corwin, Daniel J., et al. "Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic." Pediatric Emergency Care, vol. 36, no. 11, 2020, pp. 554-558.
Corwin DJ, Sartori LF, Chiotos K, et al. Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic. Pediatr Emerg Care. 2020;36(11):554-558.
Corwin, D. J., Sartori, L. F., Chiotos, K., Odom John, A. R., Cohn, K., Bassiri, H., Behrens, E. M., Teachey, D. T., Henrickson, S. E., Diorio, C. J., Zorc, J. J., & Balamuth, F. (2020). Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic. Pediatric Emergency Care, 36(11), 554-558. https://doi.org/10.1097/PEC.0000000000002248
Corwin DJ, et al. Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic. Pediatr Emerg Care. 2020;36(11):554-558. PubMed PMID: 32970023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic. AU - Corwin,Daniel J, AU - Sartori,Laura F, AU - Chiotos,Kathleen, AU - Odom John,Audrey R, AU - Cohn,Keri, AU - Bassiri,Hamid, AU - Behrens,Edward M, AU - Teachey,David T, AU - Henrickson,Sarah E, AU - Diorio,Caroline J, AU - Zorc,Joseph J, AU - Balamuth,Fran, PY - 2020/9/25/pubmed PY - 2020/11/13/medline PY - 2020/9/24/entrez SP - 554 EP - 558 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 36 IS - 11 N2 - OBJECTIVE: The aim of the study was to compare presenting clinical and laboratory features among children meeting the surveillance definition for multisystem inflammatory syndrome in children (MIS-C) across a range of illness severities. METHODS: This is a retrospective single-center study of patients younger than 21 years presenting between March 1 and May 15, 2020. Included patients met the Centers for Disease Control and Prevention criteria for MIS-C (inflammation, fever, involvement of 2 organ systems, lack of alternative diagnoses). We defined 3 subgroups by clinical outcomes: (1) critical illness requiring intensive care interventions; (2) patients meeting Kawasaki disease (KD) criteria but not requiring critical care; and (3) mild illness not meeting either criteria. A comparator cohort included patients with KD at our institution during the same time frame in 2019. RESULTS: Thirty-three patients were included (5, critical; 8, 2020 KD; 20, mild). The median age for the critical group was 10.9 years (2.7 for 2020 KD; 6.0 for mild, P = 0.033). The critical group had lower median absolute lymphocyte count (850 vs 3005 vs 2940/uL, P = 0.005), platelets (150 vs 361 vs 252 k/uL, P = 0.005), and sodium (129 vs 136 vs 136 mmol/L, P = 0.002), and higher creatinine (0.7 vs 0.2 vs 0.3 mg/dL, P = 0.002). In the critical group, 60% required vasoactive medications, and 40% required mechanical ventilation. Clinical and laboratories features were similar between the 2020 and 2019 KD groups. CONCLUSIONS: We describe 3 groups with inflammatory syndromes during the SARS-CoV-2 pandemic. The initial profile of lymphopenia, thrombocytopenia, hyponatremia, and abnormal creatinine may help distinguish critically ill MIS-C patients from classic/atypical KD or more benign acute inflammation. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/32970023/Distinguishing_Multisystem_Inflammatory_Syndrome_in_Children_From_Kawasaki_Disease_and_Benign_Inflammatory_Illnesses_in_the_SARS_CoV_2_Pandemic_ L2 - https://doi.org/10.1097/PEC.0000000000002248 DB - PRIME DP - Unbound Medicine ER -