Multisystem Inflammatory Syndrome in Children (MIS-C) Evaluation in Non-Toxic Appearing Patients

Multisystem Inflammatory Syndrome in Children (MIS-C) Evaluation in Non-Toxic Appearing Patients in Emergency Departments

• How should I initially evaluate and manage my patient?

  For ambulatory evaluation for MIS-C in the non-ill appearing child for emergency departments, evaluate the patient for the following:

  • Child presenting with fever >38.0°C or report of subjective fever lasting ≥ 3 days
  • No compelling alternative diagnosis
  • 2 or more of the following:
    • Skin: Rash, desquamation/peeling
    • GI: Severe abdominal pain, nausea, vomiting, PO intolerance, diarrhea
    • Respiratory: Cough, shortness of breath, hypoxia
    • ENT: Mucous membrane changes, conjunctivitis
    • Neurology: Headache, stiff neck, vision changes
    • Musculoskeletal: Myalgia, arthralgia
    • Hematology: Pallor, lymphadenopathy
    • Cardiac: Chest pain, dyspnea, syncope, dizziness, fatigue
  • Please note: Some individuals may fulfill full or partial criteria for Kawasaki Disease

• When should I refer my patient?

  If your patient has a fever or report of subjective fever lasting more than 3 days, 2 or more of the symptoms listed above and no compelling alternative diagnosis you should obtain workup to evaluate doe possible MIS-C. Tier 1 should be done at the referring center and includes labs for CBC, CRP, ESR, CMP, D-Dimer, Ferritin, Troponin, BNP and if possible: SARS CoV2 PCR.

  If MIS-C is less likely:

  • Consider other possible etiologies for illness and evaluate appropriately.
  • Recommend follow-up within 24 hours to monitor clinical progress.
  • Discharge with strict return precautions; recommend return for further workup if symptoms persist or worsen.

• How can I refer my patient?

  To discuss the case with the Children's National Hospital Emergency Department, please call 202-476-5433 to discuss with an ED intake specialist.

• What can my patient expect from a visit to Children's National?

  The patients Tier 2 labs will be done in consult with Children's National, or on arrival to Children's National. Labs include: LDH, Fibrinogen, Triglycerides, PT/PTT/INR, Urinalysis, Urine random protein to creatinine ratio, CXR, EKG, SARS CoV2 Antibody IgG.

Multisystem Inflammatory Syndrome in Children (MIS-C) Evaluation in Non-Toxic Appearing Patients in Primary and Urgent Care

• How should I initially evaluate and manage my patient?

  For ambulatory evaluation for MIS-C in the non-ill appearing child for emergency departments, evaluate the patient for the following:

  • Child presenting with fever >38.0°C or report of subjective fever lasting ≥ 3 days
  • No compelling alternative diagnosis
  • 2 or more of the following:
    • Skin: Rash, desquamation/peeling
    • GI: Severe abdominal pain, nausea, vomiting, PO intolerance, diarrhea
    • Respiratory: Cough, shortness of breath, hypoxia
    • ENT: Mucous membrane changes, conjunctivitis
    • Neurology: Headache, stiff neck, vision changes
    • Musculoskeletal: Myalgia, arthralgia
    • Hematology: Pallor, lymphadenopathy
    • Cardiac: Chest pain, dyspnea, syncope, dizziness, fatigue
  • Please note: Some individuals may fulfill full or partial criteria for Kawasaki Disease

• When should I refer my patient?

  If your patient has a fever or report of subjective fever lasting more than 3 days, 2 or more of the symptoms listed above and no compelling alternative diagnosis you should obtain outpatient screening  workup to evaluate for possible MIS-C, CBC, ESR, CRP.

  If MIS-C is less likely:

  • Consider other possible etiologies for illness and evaluate appropriately.
  • Recommend follow-up within 24 hours to monitor clinical progress.
  • Discharge with strict return precautions; recommend return for further workup if symptoms persist or worsen.

• How can I refer my patient?

  To discuss the case with an Infectious Disease/ COVID-19 provider, please call 202-476-5000 and ask to have the person holding the COVID-19 pager called.

  If admission is recommended, call the Children's National Emergency Department at 202-476-5433 to discuss with an ED intake specialist.