Exclusion of Alternative Diagnoses in Children with Suspected Pimsts Referred to a Regional Critical Care Transport Service in the Uk: A Retrospective Audit

ABSTRACT

BACKGROUND AND AIM: Paediatric inflammatory multisystem syndrome temporally related with COVID-19 (PIMS-TS) has considerable overlap in presentation with Kawasaki disease, sepsis, toxic shock syndrome, and surgical abdominal pathology. National consensus guidelines were published in the United Kingdom in September 2020, detailing investigations that should be undertaken to exclude other diagnoses. This retrospective audit aimed to assess referrals to our regional critical care transport service to ascertain whether alternative diagnoses are being excluded in children with suspected PIMS-TS. METHOD(S) 66 referrals were made to the transport service from September 2020 to 2021 with a provisional diagnosis of COVID-19, PIMS-TS, atypical Kawasaki disease, acute abdomen or cardiac disease. Referral documentation was examined and excluded if PIMS-TS was not suspected, leaving a total of 41 referrals for audit. Documentation was examined for evidence of completion by the referring team of sepsis screen and abdominal imaging. RESULT(S) 24 (59%) patients had a sepsis screen already completed prior to referral. Of the remaining 17 referrals, 16 (94%) did not have a sepsis screen recommended by the transport service. 27 (66%) referrals had abdominal symptoms on referral. Of these, 9 (33%) had received abdominal imaging, 6 (22%) were recommended to receive imaging by the transport service, and 12 (44%) were not recommended to receive imaging. CONCLUSION(S) The majority of patients referred to the regional transport service had received a sepsis screen prior to referral. However the majority of patients with abdominal symptoms did not receive imaging. A referral proforma for suspected PIMS-TS patients has been developed to improve exclusion of alternative diagnoses.