A national consensus management pathway for Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS): The results of a national Delphi process

Abstract

Objective: To develop a consensus management pathway for children with Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS). Design: A three-phase online Delphi process and virtual consensus meeting sought consensus over the investigation, management and research priorities from 98 multidisciplinary participants caring for children with PIMS-TS. 46 participants (47%) completed all three phases. Participants were grouped into three panels and scored each statement from 1 (disagree) to 9 (strongly agree). In phase two participants were shown their panels scores, and in phase three all panels scores. Consensus agreement was defined as ≥70% of participants in each panel scoring the statement 7-9, and <15% scoring 1-3, and consensus disagreement was the opposite of this. Statements which achieved consensus in 2/3 panels were discussed at the consensus meeting, and when ≥70% participants agreed with the statement it achieved consensus. Results: 255 statements were assessed, with consensus agreement achieved for 111 (44%), consensus disagreement for 29 (11%), and no consensus for 115 (45%). The 140 consensus statements were used to derive the consensus management pathway. Conclusions: A national consensus pathway has been developed for children suspected of having the novel syndrome PIMS-TS in a timely, cost-efficient manner, in the midst of a global pandemic. Use of a rapid online Delphi process has made this consensus process possible. Future evidence will inform updates to this guidance, which in the interim provides a solid framework to support clinicians caring for children with PIMS-TS.

Multisystem inflammatory syndrome in children related to COVID-19: An update regarding the presentation of two critically ill patients

“…children presenting with shock and/or fever and gastrointestinal, respiratory or neurological symptoms that do not meet KD criteria. 22 Sixty-eight percent of patients reported in the different series [13][14][15][16][17][18][19][20] analyzed in this article (N = 1092) did not have a prior disease. O v e r w e i g h t a n d o b e s i t y w e r e t h e m a i n concomitant conditions.…”

“…Harwood et al segmented the treatment based on the presenting phenotype (KD or non-specific). 22 In both sub-types, IVIG is the first-line treatment (2 g/kg), and a second dose may be needed. Low-dose corticosteroids are proposed as an optional treatment in the case of both phenotypes.…”

“…Infliximab is indicated for the KD phenotype, whereas there is no consensus among tocilizumab, anakinra, and infliximab for the nonspecific presentation. 22 The recommendations mentioned in the bibliography are summarized in Figure 2.…”

“…13 The different published series indicate that mortality due to MIS-C is close to 2 %, with a high incidence of admissions to the pediatric intensive Review care unit (PICU) and a high rate of multiple organ support therapy. [13][14][15][16][17][18][19][20] Guidelines developed by the American College of Rheumatology 21 and a recent consensus have been published as guidance to the diagnostic approach of MIS-C. 22 Both guidelines recommend organ support, stepwise progression of immunomodulatory therapy based on disease course and treatment response, and antiplatelet and/or anticoagulation therapy. 21,22 Our objective is to describe the presentation, course, and treatment implemented in two p a t i e n t s w i t h M I S -C a n d t o p e r f o r m a bibliographic review of this syndrome.…”

“…Diagnostic and therapeutic algorithm for patients with multisystem inflammatory syndrome in children RT-PCR: reverse transcription polymerase chain reaction; CBC: complete blood count; LFT: liver function tests; ABS: acid-base status; NT-proBNP: N-terminal pro-B-type natriuretic peptide; LDH: lactate dehydrogenase; BC: blood cultures; IIF: indirect immunofluorescence of nasopharyngeal secretions; ECG: electrocardiogram; IVIG: intravenous immunoglobulin; IL: interleukin. Obtained and modified from the American College of Rheumatology 21 and Harwood R 22. …”