Identifying pediatric patients with multisystem inflammatory syndrome in children presenting to a pediatric emergency department
Identifying pediatric patients with multisystem inflammatory syndrome in children presenting to a pediatric emergency department
复制标题
DOI：
10.1016/j.ajem.2021.10.011
复制
发表时间：
2021-10-21
影响因子：
3.6
通讯作者：
Breslin, Kristen A.
中科院分区：
文献类型：
--
作者：
Kline, Jaclyn N.;Isbey, Sarah C.;Breslin, Kristen A.
目的：比较儿童多系统炎症综合征(MIS-C)与急诊科(ED)的临床和实验室特点。方法：我们对2020年3月1日至2020年7月31日在城市三级护理儿科急诊室遇到炎症标志物检测的病历进行了回顾。我们提取了人口统计信息、实验室价值、选定的药物和诊断。我们复习了入院的疑似患者的临床表现记录。然后，我们使用受试者操作曲线和Logistic回归来评估候选实验室值预测管理信息系统-C状态的有效性。结果：我们确定了32例确诊的MIS-C患者和15例因MIS-C入院并进行评估但未确认SARS CoV-2感染的患者。我们将这些患者与267例在MISC筛查实验室中遇到的患者进行了比较。确诊的MIS-C患者的中位年龄较大，发病时中位发烧较高，主要是西班牙裔和非西班牙裔黑人。所有患者的C反应蛋白(CRP)水平均为4.5 mg/dL，脑利钠肽水平为400pg/ml(OR10.50，95%CI为4.40~25.04)，D-二聚体水平为3mUg/mL(7.51，3.18~17.73)，淋巴细胞绝对计数(ALC)为4.5 mg/dL和ALC。
Objective: To compare clinical and laboratory features of children with Multisystem Inflammatory Syndrome in Children (MIS-C) to those evaluated for MIS-C in the Emergency Department (ED). Methods: We conducted a retrospective review of the medical record of encounters with testing for inflammatory markers in an urban, tertiary care Pediatric ED from March 1, 2020 to July 31, 2020. We abstracted demographic information, laboratory values, selected medications and diagnoses. We reviewed the record for clinical presentation for the subset of patients admitted to the hospital for suspected MIS-C. We then used receiver operating curves and logistic regression to evaluate the utility of candidate laboratory values to predict MIS-C status. Results: We identified 32 patients with confirmed MIS-C and 15 admitted and evaluated for MIS-C but without confirmation of SARS CoV-2 infection. We compared these patients to 267 encounters with screening laboratories for MIS-C. Confirmed MIS-C patients had an older median age, higher median fever on presentation and were predominantly of Hispanic and non-Hispanic Black race/ethnicity. All children with MIS-C had a C reactive protein (CRP) >4.5 mg/dL, were more likely to have Brain Natriuretic Peptide >400 pg/mL (OR 10.50, 95% CI 4.40-25.04), D-Dimer >3 mu g/mL (7.51, [3.18-17.73]), and absolute lymphocyte count (ALC) 4.5 mg/dL and ALC