Creation of prediction tool to guide further workup of febrile children in the emergency department under consideration for Multisystem Inflammatory Syndrome in children

Abstract

Background

Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of COVID-19 in children. Its workup often necessitates extensive laboratory investigations.

Objectives

This project sought to provide pediatric acute care providers with a data-based tool to guide further decision-making during initial workups for children under consideration for MIS-C.

Methods

We compared documented physical findings and laboratory data (complete blood counts, inflammatory markers, and electrolytes) from MIS-C cases (n = 46) to control data extracted from a pre-pandemic database of febrile children (n = 70). Significant findings on Fisher's exact test and independent t-tests were used to develop a scoring model. Receiver operating characteristic (ROC) curve analysis was performed to assess this scoring system using two different cohorts of MIS-C.

Results

From initial comparative analysis, a score (≥3) utilizing levels of CRP, lymphocytes, platelets, and total white blood cells was developed. ROC curve analysis demonstrated excellent parameters, with overall sensitivity of 97.83 %. In children <9 years old, the score had a sensitivity of 96.15 % and in ≥9 years old, the score demonstrated a sensitivity of 100.00 %. We validated the score on a geographically disparate cohort by showing a sensitivity of 88.37 % of all children and 94.74 % in children ≥2 years of age.

Conclusion

Use of this scoring system based on readily available laboratory values can eliminate many febrile children from consideration of MIS-C allowing front-line providers to focus more extensive laboratory evaluations and extended observation on fewer children with a higher likelihood of having MIS-C.