Multisystem Inflammatory Syndrome in Children: Tools for a Timely Diagnosis in the Emergency Department from an Italian Multicenter Survey

Authors

  • Angela Mauro Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Mauro A Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Maglione M Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Savoia F Childhood Cancer Registry of Campania, Santobono-Pusilipon Children’s Hospital, Naples, Italy
  • Calvi M Pediatric Emergency Department, Papa Giovanni XXIII Hospytal, Bergamo, Italy
  • Amoroso A Pediatric Emergency Department, Papa Giovanni XXIII Hospytal, Bergamo, Italy
  • Sangerardi M Pediatrics and Emergency, Giovanni XXIII Pediatric Hospital, Azienda Ospedaliero-Universitaria Consorziale "Policlinico-GiovanniXXIII", Bari, Italy
  • Tubino B Emergency Department, Giannina Gaslini children’s Hospital, Genova, Italy
  • Piccotti E Emergency Department, Giannina Gaslini children’s Hospital, Genova, Italy
  • Fabi M Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  • Salvadei S Emergency Department, Meyer Children's Hospital, Florence, Italy
  • Gadda D Pediatric Emergency Department, F. Del Ponte Hospital, ASST Sette Laghi, Varese, Italy
  • Marchetti F Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, AUSL della Romagna, Italy
  • Midullà F Policlinico “Umberto I” Università degli studi “La Sapienza”- Roma, Italy
  • Buonsenso D Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  • Stanco M Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Magrassi S Pediatric and pediatric emergency unit, Children hospital, AO SS Antonio e Biagio e C Arrigo, Alessandria, Italy
  • Salvini F PediatricEmergency Department, Grande Ospedale Metropolitano Niguarda, Milano, Italy
  • Pignataro R Department of pediatrics, Maggiore Hospital, Lodi, Italy
  • Di Florio F Ospedale Maggiore- Bologna
  • Del Giudice E UOC Pediatria, Università degli Studi “La Sapienza”, Polo Pontino- Latina
  • Bernardo L 25Department of Childhood and Developmental Medicine, Fatebenefratelli – Sacco Hospital, Milano
  • Lubrano R
  • Tipo V Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Rosa M Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Gagliardi T Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Picciano L Emergency Department and short stay Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Gagliardi S General pediatric and neonatology department, I Martiri Di Villa Malta Hospital, Sarno, Italy
  • Orlando F Department of Pediatrics, Rheumatology Unit, Santobono- Pusilipon Children’s Hospital, Naples, Italy
  • Bellani I Pediatric Emergency Department, Papa Giovanni XXIII Hospytal, Bergamo, Italy
  • Canzaniga V Pediatric Emergency Department, Papa Giovanni XXIII Hospytal, Bergamo, Italy
  • Medici F Pediatric Emergency Department, Papa Giovanni XXIII Hospytal, Bergamo, Italy
  • La Torre F Department of Pediatrics, Giovanni XXIII Pediatric Hospital, Azienda Ospedaliero-Universitaria Consorziale "Policlinico- Giovanni XXIII", Bari, Italy
  • Cardinale F Department of Pediatrics, Giovanni XXIII Pediatric Hospital, Azienda Ospedaliero-Universitaria Consorziale "Policlinico- Giovanni XXIII", Bari, Italy
  • Tibaldi J Emergency Department, Giannina Gaslini children’s Hospital, Genova, Italy
  • Schiappapietra B Emergency Department, Giannina Gaslini children’s Hospital, Genova, Italy
  • D’Alessandro M Emergency Department, Giannina Gaslini children’s Hospital, Genova, Italy
  • Bitelli M Specialty School of Pediatrics - Alma Mater Studiorum, Università di Bologna, Bologna, Italy
  • Gallotta G Specialty School of Pediatrics - Alma Mater Studiorum, Università di Bologna, Bologna, Italy
  • Masi S Emergency Department, Meyer Children's Hospital, Florence, Italy
  • Nucci A Emergency Department, Meyer Children's Hospital, Florence, Italy
  • Agosti M Woman and Child Department, ASST Sette Laghi, Varese, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
  • Plebani AM Pediatric Emergency Department, F. Del Ponte Hospital, ASST Sette Laghi, Varese, Italy
  • Iacono A Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, AUSL della Romagna, Italy
  • Cairello F Pediatric and pediatric emergency unit, Children hospital, AO SS Antonio e Biagio e C Arrigo, Alessandria, Italy
  • Ghizzi C Ospedale Maggiore- Bologna
  • Rossi N Department of Pediatric, SS. Annunziata University Hospital, Chieti, Italy
  • Schiavone I Department of Pediatrics, San Giuseppe Moscati Hospital, Aversa, Italy
  • Gentile A Department of Pediatrics, Antonio Perrino Hospital, Brindisi, Italy

DOI:

https://doi.org/10.12974/2311-8687.2023.11.07

Keywords:

Systemic Inflammation, Pediatric, COVID-19, MIS-C

Abstract

Objective: To assess the most frequent clinical features of Multisystem Inflammatory Syndrome in children (MIS-C) at presentation to the Emergency Department (ED) in a large multicenter cohort of patients, in order to define useful tools for a timely diagnosis. Methods: Clinical and laboratory characteristics were retrospectively reviewed for 210 MIS-C patients from 18 Italian pediatric EDs. We assessed correlations between clinical and laboratory parameters and compared features of patients of different age (≤5 years and >5 years). Results: Fever was the main presenting symptom (100%), followed by conjunctivitis (46%), abdominal pain (44%), vomiting (41%) and diarrhea (39%). Forty-nine percent of children presented to the ED in critical or nearly critical condition. A higher prevalence of mucocutaneous involvement was found in younger children (69% versus 47%, p<0.05), whereas gastrointestinal symptoms were more common in children >5 years (62% versus 85%, p<0.05). Higher values of inflammatory markers (C-Reactive Protein, Ferritin, and Fibrinogen), Troponin T and Brain Natriuretic Peptide were related to abnormal echocardiography (p<0.05). No significant differences were detected in laboratory parameters between the two age groups, apart from ferritin, fibrinogen and troponin T, which resulted significantly lower in children ≤5 years. Conclusions: Apart from fever, the most common MIS-C manifestations at presentation to the ED are conjunctivitis, abdominal pain, vomiting and diarrhea. Younger children more frequently present with mucocutaneous involvement, while gastrointestinal manifestations are more common in older patients. These findings should be considered when MIS-C is suspected in the ED, in order to achieve a timely recognition of the condition.

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Published

2023-06-22

How to Cite

Mauro, A. ., A, M., M, M. ., F, S. ., M, C., A, A. ., M, S. ., B, T. ., E, P. ., M, F. ., S, S. ., D, G. ., F, M. ., F, M. ., D, B. ., M, S. ., S, M. ., F, S. ., R, P. ., F, D. F. ., E, D. G. ., L, B. ., R, L. ., V, T. ., M, R. ., T, G. ., L, P. ., S, G. ., F, O. ., I, B. ., V, C., F, M. ., F, L. T. ., F, C. ., J, T. ., B, S. ., M, D. ., M, B. ., G, G., S, M. ., A, N. ., M, A. ., AM, P. ., A, I. ., F, C. ., C, G. ., N, R. ., I, S. ., & A, G. . (2023). Multisystem Inflammatory Syndrome in Children: Tools for a Timely Diagnosis in the Emergency Department from an Italian Multicenter Survey. International Journal of Pediatrics and Child Health, 11, 39–49. https://doi.org/10.12974/2311-8687.2023.11.07

Issue

Vol. 11 (2023)

Section

Articles