tetano
Editor, Senior Moderator
Pediatr Crit Care Med
. 2022 Aug 22.
doi: 10.1097/PCC.0000000000003054. Online ahead of print.
Characteristics and Outcomes of Critically Ill Children With Multisystem Inflammatory Syndrome
Kellie Snooks[SUP] 1 [/SUP], Matthew C Scanlon[SUP] 1 [/SUP], Kenneth E Remy[SUP] 2 [/SUP], Steven L Shein[SUP] 2 [/SUP], Margaret J Klein[SUP] 3 [/SUP], Janine Zee-Cheng[SUP] 4 [/SUP], Colin M Rogerson[SUP] 4 [/SUP], Alexandre T Rotta[SUP] 5 [/SUP], Anna Lin[SUP] 6 [/SUP], Casey K McCluskey[SUP] 7 [/SUP], Christopher L Carroll[SUP] 8 [/SUP]
Affiliations
Abstract
Objectives: To characterize the prevalence of pediatric critical illness from multisystem inflammatory syndrome in children (MIS-C) and to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain on outcomes.
Design: Retrospective cohort study.
Setting: Database evaluation using the Virtual Pediatric Systems Database.
Patients: All children with MIS-C admitted to the PICU in 115 contributing hospitals between January 1, 2020, and June 30, 2021.
Measurements and main results: Of the 145,580 children admitted to the PICU during the study period, 1,338 children (0.9%) were admitted with MIS-C with the largest numbers of children admitted in quarter 1 (Q1) of 2021 (n = 626). The original SARS-CoV-2 viral strain and the D614G Strain were the predominant strains through 2020, with Alpha B.1.1.7 predominating in Q1 and quarter 2 (Q2) of 2021. Overall, the median PICU length of stay (LOS) was 2.7 days (25-75% interquartile range [IQR], 1.6-4.7 d) with a median hospital LOS of 6.6 days (25-75% IQR, 4.7-9.3 d); 15.2% received mechanical ventilation with a median duration of mechanical ventilation of 3.1 days (25-75% IQR, 1.9-5.8 d), and there were 11 hospital deaths. During the study period, there was a significant decrease in the median PICU and hospital LOS and a decrease in the frequency of mechanical ventilation, with the most significant decrease occurring between quarter 3 and quarter 4 (Q4) of 2020. Children admitted to a PICU from the general care floor or from another ICU/step-down unit had longer PICU LOS than those admitted directly from an emergency department.
Conclusions: Overall mortality from MIS-C was low, but the disease burden was high. There was a peak in MIS-C cases during Q1 of 2021, following a shift in viral strains in Q1 of 2021. However, an improvement in MIS-C outcomes starting in Q4 of 2020 suggests that viral strain was not the driving factor for outcomes in this population.
. 2022 Aug 22.
doi: 10.1097/PCC.0000000000003054. Online ahead of print.
Characteristics and Outcomes of Critically Ill Children With Multisystem Inflammatory Syndrome
Kellie Snooks[SUP] 1 [/SUP], Matthew C Scanlon[SUP] 1 [/SUP], Kenneth E Remy[SUP] 2 [/SUP], Steven L Shein[SUP] 2 [/SUP], Margaret J Klein[SUP] 3 [/SUP], Janine Zee-Cheng[SUP] 4 [/SUP], Colin M Rogerson[SUP] 4 [/SUP], Alexandre T Rotta[SUP] 5 [/SUP], Anna Lin[SUP] 6 [/SUP], Casey K McCluskey[SUP] 7 [/SUP], Christopher L Carroll[SUP] 8 [/SUP]
Affiliations
- PMID: 35994614
- DOI: 10.1097/PCC.0000000000003054
Abstract
Objectives: To characterize the prevalence of pediatric critical illness from multisystem inflammatory syndrome in children (MIS-C) and to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain on outcomes.
Design: Retrospective cohort study.
Setting: Database evaluation using the Virtual Pediatric Systems Database.
Patients: All children with MIS-C admitted to the PICU in 115 contributing hospitals between January 1, 2020, and June 30, 2021.
Measurements and main results: Of the 145,580 children admitted to the PICU during the study period, 1,338 children (0.9%) were admitted with MIS-C with the largest numbers of children admitted in quarter 1 (Q1) of 2021 (n = 626). The original SARS-CoV-2 viral strain and the D614G Strain were the predominant strains through 2020, with Alpha B.1.1.7 predominating in Q1 and quarter 2 (Q2) of 2021. Overall, the median PICU length of stay (LOS) was 2.7 days (25-75% interquartile range [IQR], 1.6-4.7 d) with a median hospital LOS of 6.6 days (25-75% IQR, 4.7-9.3 d); 15.2% received mechanical ventilation with a median duration of mechanical ventilation of 3.1 days (25-75% IQR, 1.9-5.8 d), and there were 11 hospital deaths. During the study period, there was a significant decrease in the median PICU and hospital LOS and a decrease in the frequency of mechanical ventilation, with the most significant decrease occurring between quarter 3 and quarter 4 (Q4) of 2020. Children admitted to a PICU from the general care floor or from another ICU/step-down unit had longer PICU LOS than those admitted directly from an emergency department.
Conclusions: Overall mortality from MIS-C was low, but the disease burden was high. There was a peak in MIS-C cases during Q1 of 2021, following a shift in viral strains in Q1 of 2021. However, an improvement in MIS-C outcomes starting in Q4 of 2020 suggests that viral strain was not the driving factor for outcomes in this population.