Objectives Given the significant overlap of multisystem inflammatory syndrome in children (MIS-C) with other common childhood illnesses presenting to the emergency department, extensive workup of this syndrome has become necessary. Nevertheless, little has been published on the factors differentiating MIS-C from other conditions in the acute care setting. We investigated differences in presentation and laboratory studies between suspected versus confirmed MIS-C patients. Methods This was a retrospective cohort study on patients 21 years or younger undergoing investigation for possible MIS-C at a single institution between April 21 and July 1, 2020. The primary outcome was diagnosis of MIS-C or an alternative final diagnosis. Clinical features and laboratory findings from initial presentation were collected and analyzed. Results A total of 106 patients (median, 4 years; 55.7% male) were included, of whom 17 (16%) of 106 met the criteria for MIS-C. Multisystem inflammatory syndrome in children patients were significantly more likely to report a coronavirus disease 2019 exposure (odds ratio (OR), 13.17 [3.87–44.9]), have gastrointestinal symptoms (OR, 3.81 [1.02–14.19]), and have a significantly higher odds of having abnormal laboratory values including high-sensitivity troponin T (OR, 13 [4.0–42.2]), N-terminal B-type natriuretic peptide (OR, 8.4 [2.3–30.1]), D-dimer (OR, 13 [1.6–103]), and ferritin (OR, 7.8 [2.2–27.2]). There were also differences between groups in inflammatory markers: C-reactive protein (median, 134.45 mg/L vs 12.6 mg/L; P < 0.05) and procalcitonin (1.71 ng/mL vs 0.14 ng/mL; P < 0.001). Conclusions Higher elevations in key laboratory studies may help to distinguish between MIS-C patients and non–MIS-C patients presenting to the emergency department.

INTRODUCTION: Many of the 20 million college students in the U.S. access contraception through student health centers, but little is known about how college health providers approach contraceptive counseling and provision. METHODS: We surveyed 87 New England college health providers about contraceptive counseling practices and on site availability of contraceptives, especially intrauterine devices and subdermal implants (long-acting reversible contraception= LARC). Providers were also surveyed about their IUD/implant training and comfort level with insertion. Descriptive statistical analyses were conducted using STATA 13.2. RESULTS: Most respondents (57%) were nurse practitioners, 17% were registered nurses, and 11% were medical doctors. Providers ranked oral contraceptive methods as most popular with students and reported that students chose LARC methods less than 10% of the time. Providers felt that IUDs and implants were appropriate methods for this population, however few (<15%) provided LARC methods themselves. Most students had to be referred off-campus for further services. Providers had some experience with LARC training. 75% of providers reported classroom training with IUDs and implants, while 30-50% had hands-on insertion training. Despite these training experiences, nearly all providers reported they were uncomfortable with IUD and implant insertion. Barriers to LARC uptake included insufficient volume or experience, institutional policies, and student unfamiliarity with the methods. CONCLUSION: While college student healthcare providers are enthusiastic about LARC methods, few have insertion experience or are comfortable with follow-up care. Further research should address whether increased on-campus accessibility would increase student uptake as well as development of supplemental college healthcare provider training to increase comfort with LARC insertion.

ObjectivesThis study aimed to assess whether elevations in cardiac biomarkers are associated with pediatric cardiac diagnoses in the era of COVID-19 and multisystem inflammatory syndrome in children (MIS-C).Study DesignThis single-center retrospective study analyzed children with a troponin drawn in the emergency department or inpatient unit between April 21 and December 31, 2020. The primary outcome was the presence of a cardiac diagnosis or MIS-C. Relationships among demographics, complaint, cardiac diagnostics, and cardiac biomarkers were analyzed.ResultsFour hundred eighty-six patients (mean ± SD; age 13.1 ± 7.8 years; 46.7% women) met inclusion criteria, for whom a cardiac diagnosis (excluding MIS-C) was made in 27 (5.6%) patients, with MIS-C diagnosed in 14 (2.9%) patients. The sensitivity and specificity of an elevated initial high-sensitivity troponin T (hsTropT) value (>14 ng/L) in predicting the composite outcome of a cardiac diagnosis or MIS-C were 54% and 89%, respectively. Four percent of patients with negative initial troponin values were found to have a cardiac diagnosis or MIS-C. Multivariable regression analysis demonstrated that elevated hsTropT (>14 ng/L; odds ratio [OR] [95% confidence interval]: 4.9 [1.70–14.0]) and elevated N-terminal pro B-type natriuretic peptide values (>500 pg/mL; 6.4 [2.01–20.1]) were associated with increased odds of a cardiac diagnosis or MIS-C.ConclusionsChildren with elevated cardiac biomarkers have increased odds of a cardiac diagnosis or MIS-C and warrant workup regardless of indication for testing. Although a negative hsTropT may reassure providers, further investigation is critical in developing algorithms to reliably exclude cardiac disease.

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