The Center for Disease Control and Prevention (CDC) gave the following definition for MIS-C: An individual aged <21 years presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); no alternative plausible diagnoses, and a positive SARS-CoV-2 test or exposure. Physicians in New York noted that these children can deteriorate quickly. Despite these severe symptoms, the majority of children with MIS-C survive. So far clinicians agree that this is an inflammatory response reaction to a viral infection similar to Kawasaki disease in some ways, yet distinct and specific to SARS-CoV-2. ^6,7

While screening guidelines and recommendations for treating MIS-C are evolving, Children’s Hospital of Philadelphia released a pathway that is updated often and easy for physicians to follow. This is one tool pediatric providers can use in the community and the emergency department to screen for MIS-C. ⁸

The Children’s Healthcare of Atlanta (CHOA) MIS-C ED workflow algorithm is similar see copy below. If you have a patient with concerning symptoms please call the transfer center at 404-785-7778 and ask to speak with an ED physician at the CHOA campus you will refer the patient to.  Any patient with unstable vital signs, that cannot obtain further outpatient workup, with complex medical history, or that has delayed outpatient laboratory results should be transferred CHOA for further workup. Furthermore, any patient a community pediatrician feels uncomfortable managing should be transferred for further evaluation. Our understanding of SARS-CoV-2 in children and MIS-C is ever-evolving so it is important to continue to review current peer-reviewed literature to remain updated.

For referral of patients to Children’s please call 404-785-7778 please explicitly give your concerns for MIS-C to Transfer center nurse.

1. Dong, Yuanyuan, et al. “Epidemiology of COVID-19 among children in China.” Pediatrics (2020).
2. Parri, Niccolò, Matteo Lenge, and Danilo Buonsenso. “Children with Covid-19 in Pediatric Emergency Departments in Italy.” New England Journal of Medicine (2020).
3. Castagnoli, Riccardo, et al. “Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review.” JAMA pediatrics (2020)
4. Verdoni, Lucio, et al. “An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study.” The Lancet (2020)
5. Riphagen, Shelley, et al. “Hyperinflammatory shock in children during COVID-19 pandemic.” The Lancet (2020)
6. New York State Department of Health Webinar. Covid Related Pediatric Multi-System Inflammatory Syndrome. May 14, 2020. Available at https://totalwebcasting.com/view/?id=nysdohcovid.  
7. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). Center for Disease Control and Prevention. https://emergency.cdc.gov/han/2020/han00432.asp. Accessed May 27, 2020.
8. Emergency Department, ICU and Inpatient Clinical Pathway for Evaluation of Possible Multisystem Inflammatory Syndrome (MIS-C). Children’s Hospital of Philadelphia. Available at https://www.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway. Accessed May 27, 2020.

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