PIMS-TS: Neurological, quality of life and adaptive functioning outcomes and associated factors

ABSTRACT

Background: Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) causes prolonged hospitalisation and morbidity. The longer term neurological and health outcomes in children following PIMS-TS are largely unknown. Methods: In this single-institution study, we evaluated the domains of daily living, physical, emotional, and quality of life outcomes at 6 months following PIMS-TS. Data were collected by telephone questionnaire interviews with parents and children and also using standardized assessment tools -PedsQL-Multidimensional Fatigue Scale, and Paediatric Symptom Checklist (PSC). Results: Data were obtained from 81 children admitted with PIMS-TS between April and August 2020. 49 were males (60%) and 52 (63%) non-white. Median age was 9 years (8-17 years) with length of stay of 6 days (range 1-22 days). Prior to discharge, 34 children (42%) had difficulties with activities of daily living whereas only 5 (6%) persisted on 6 months follow up. Exercise intolerance/mobility difficulty was observed in 40 children (9%) at discharge compared to 20 (25%) 6 months later. Predictors associated with difficulty in exercise tolerance/mobility were obesity (OR=4.0;95% CI 1.1-13.7;p=0.03) and older age (OR=1.1;95% CI 0.99-1.3;p=0.086). Inflammatory markers on admission (CRP, fibrinogen, D-dimer and ferritin) did not correlate with worse outcome at follow-up nor did sex and length of stay. The PedsQL-Multidimensional Fatigue Scale revealed a median score of 94 (IQR 83-100) indicating an overall average range quality of life. The PSC were in line with population prevalence of behavioural/emotional difficulties 10% had difficulties with attention;7% and 4% of patients had internalizing and externalizing difficulties, respectively Conclusion: Overall, patients with PIMS-TS have good short-term outcomes at 6 months with respect to daily functioning, quality of life, and behaviour. One in four had some difficulty with mobility/pain requiring rehabilitation, with main risk factors being obesity and older age. Further studies are required to evaluate long-term sequelae.