Early recognition of multisystem inflammatory syndrome temporally associated to COVID-19 in the emergency department: A single tertiary care centre experience

ABSTRACT

Introduction: Multisystem Inflammatory Syndrome in Children (MISC) is a new and life-threatening disease temporally associated to Covid-19. Objectives: The aim of the study is to analyze the clinical, laboratoristic and instrumental features of patients with diagnosis of MIS-C at the onset in order to early recognize the disease. Methods: We retrospectively reviewed clinical records of children admitted to our Emergency Department between April 2020 and March 2021, who were ultimately diagnosed with MIS-C associated with SARS-CoV2. Data collected included all clinical and laboratory parameters at presentation to the Emergency Department. We also recorded data regarding the duration of fever and hospitalization and the presence of abnormalities at chest X-ray, abdominal and cardiac ultrasound. Results: Clinical and laboratory data of the twenty-seven children retrospectively enrolled, including symptoms at presentation to the Emergency Department, are summarized in Table 1. Median duration of fever was 4 days (range 1.5 - 7). With the exception of fever, abdominal pain and diarrhea were the most frequent complaints at presentation. No significant differences were found between laboratory parameters in children with or without abdominal pain, diarrhea, vomit, conjunctivitis or rash. Heart ultrasound showed no abnormalities in 11 out of 27 children (41%). Findings in other children were mainly represented by mild pericardial effusion (29.6%) and mild mitral valve insufficiency (25.9%). Minor abnormalities in the interventricular septal dynamics were detected in 3 subjects (11.1%). Abdominal ultrasound was unremarkable in 5 out of 27 patients (18.5%). Most children (51.8%) had mild-to-moderate peritoneal effusion, which was often associated with ileal loops wall thickening (29.6%). The thickened segments were mostly located in proximity of the ileo-cecal valve or of the appendix. Mesenteric lymphadenitis was found in eleven children (40.7%). No significant differences were found in clinical or laboratory parameters between children with abnormal heart or abdominal ultrasounds and those without pathologic findings at these exams. Chest X ray at presentation showed no significant abnormalities in most patients, and only the child who died one day after admission showed bilateral basal opacities. Conclusion: The collected data allow to identify clinical and laboratoristic tic elements of patients admitted to Emergency care unit to provide early recognition of the MIS-C .The study included a modest sample size and for this reason the generalizability of results is limited. A national multicentre study is ongoing.