421 - Predicting need for intensive care in patients with multisystem inflammatory syndrome in children in the Emergency Department

Poster Number: 421
Publication Number: 421.2793

Background: Patients with multisystem inflammatory syndrome in children (MISC) are known to have high risk of developing shock during their illness. Literature has identified laboratory findings and vital sign abnormalities that may be markers of illness severity, although temporal association has not been identified.

Objective: This study aimed to identify risk factors for intensive care utilization in patients with MISC at presentation to the emergency department (ED).

Design/Methods: We conducted a multi-center retrospective cohort analysis among patients aged 6 months to 18 years old diagnosed with MISC at five academic children’s hospitals in the United States. Subjects’ medical records were reviewed for presenting vital signs, historical and clinical symptoms, and laboratory values at initial presentation, as well as for intensive care utilization or transfer to an intensive care unit. Adjusted odds ratios were derived from a multiple logistical regression model to measure the association between collected factors and intensive care need. A sub-analysis was performed among patients transferred to the intensive care unit after initial admission to the medical floor to identify factors indicating delayed decompensation.

Results: Among 432 patients with MISC, 190 (44%) required intensive care. Factors in the ED associated with increased odds of intensive care utilization in multivariate analysis were older age, delayed capillary refill, hypotension, tachypnea, hypoxemia, and laboratory values of elevated prothrombin time, B-type natriuretic peptide, procalcitonin and alanine transaminase (Table 1). The full multivariable model exhibited a raw c-index of 0.92 and calibrated fairly with an average bootstrapped derived intercept of -0.04 and slope of 0.87 (Figure). In a sub-analysis among 40/242 (17%) patients who required transfer to the intensive care unit, the following were associated with increased odds of transfer on univariable analysis: age >12 years, higher maximum ED temperature, tachycardia >99th percentile for age, elevated D-dimer, absolute neutrophil count, and C-reactive protein (Table 2).

Conclusion(s): Presenting signs, symptoms, and laboratory findings may be utilized in the ED to identify patients with MISC who have increased odds of both initial intensive care utilization and potential later clinical deterioration. These data may help ED physicians identify patients who would benefit from more intensive monitoring or transfer to a tertiary care facility, where appropriate.