A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process.
A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process.
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DOI：
10.1016/s2352-4642(20)30304-7
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
PIMS-TS National Consensus Management Study Group
中科院分区：
文献类型：
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作者：
Harwood R;Allin B;Jones CE;Whittaker E;Ramnarayan P;Ramanan AV;Kaleem M;Tulloh R;Peters MJ;Almond S;Davis PJ;Levin M;Tometzki A;Faust SN;Knight M;Kenny S;PIMS-TS National Consensus Management Study Group
新冠肺炎相关的儿科炎性多系统综合征(PIMS-TS)是一种新的疾病，于2020年4月首次报道。我们的目标是为英国开发一个全国性的共识管理路径，为临床医生护理患有PIMS-TS的儿童提供指导。一个分三个阶段的在线Delphi流程和虚拟共识会议寻求多学科临床医生对治疗患有PIMS-TS儿童的调查、管理和研究优先事项达成共识。我们使用了140个共识声明来得出共识管理路径，该路径描述了对疑似PIMS-TS儿童的初步调查，包括帮助确定疾病严重程度的血液标记物、超声心动图以及排除其他感染性疾病原因的病毒和败血症筛查。指南中强调了多学科团队在PIMS-TS儿童决策中的重要性，以及推荐的治疗方案，包括支持性护理、静脉注射免疫球蛋白、甲基强的松龙和生物疗法。这些药物包括IL-1拮抗剂(如Anakinra)、IL-6受体阻滞剂(如tocilizumab)和抗肿瘤坏死因子药物(如英夫利昔单抗)，用于川崎病样表型和非特异性表现的儿童。利用快速在线德尔福进程，有可能在全球大流行期间以及时和具有成本效益的方式产生一条全国共识途径。共识声明代表了英国临床医生的观点，适用于英国疑似患有PIMS-TS的儿童。未来的证据将为本指南的更新提供信息，在此期间，该指南提供了一个坚实的框架，以支持临床医生照顾患有PIMS-TS的儿童。这一过程已经直接通知了新的PIMS-TS特定治疗小组，作为适应性英国恢复试验方案的一部分，这是全球首个针对PIMS-TS治疗方案的正式随机对照试验。
Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a novel condition that was first reported in April, 2020. We aimed to develop a national consensus management pathway for the UK to provide guidance for clinicians caring for children with PIMS-TS. A three-phase online Delphi process and virtual consensus meeting sought consensus over the investigation, management, and research priorities from multidisciplinary clinicians caring for children with PIMS-TS. We used 140 consensus statements to derive a consensus management pathway that describes the initial investigation of children with suspected PIMS-TS, including blood markers to help determine the severity of disease, an echocardiogram, and a viral and septic screen to exclude other infectious causes of illness. The importance of a multidisciplinary team in decision making for children with PIMS-TS is highlighted throughout the guidance, along with the recommended treatment options, including supportive care, intravenous immunoglobulin, methylprednisolone, and biological therapies. These include IL-1 antagonists (eg, anakinra), IL-6 receptor blockers (eg, tocilizumab), and anti-TNF agents (eg, infliximab) for children with Kawasaki disease-like phenotype and non-specific presentations. Use of a rapid online Delphi process has made it possible to generate a national consensus pathway in a timely and cost-efficient manner in the middle of a global pandemic. The consensus statements represent the views of UK clinicians and are applicable to children in the UK suspected of having PIMS-TS. Future evidence will inform updates to this guidance, which in the interim provides a solid framework to support clinicians caring for children with PIMS-TS. This process has directly informed new PIMS-TS specific treatment groups as part of the adaptive UK RECOVERY trial protocol, which is the first formal randomised controlled trial of therapies for PIMS-TS globally.