American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1
American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1
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DOI：
10.1002/art.41454
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发表时间：
2020-10-03
影响因子：
13.3
通讯作者：
Mehta, Jay J.
中科院分区：
文献类型：
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作者：
Henderson, Lauren A.;Canna, Scott W.;Mehta, Jay J.
目的 为儿童多系统炎症综合征 (MIS-C) 的治疗提供指导，该疾病以发热、炎症和多器官功能障碍为特征，在严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染过程的晚期表现出来，并为 2019 年冠状病毒病 (COVID-19)（SARS-CoV-2 感染的急性感染期）期间出现过度炎症的儿童提供建议。方法 美国风湿病学会 (ACR) 召集了一个多学科工作组，为与 SARS-CoV-2 和 COVID-19 中的过度炎症相关的 MIS-C 的管理提供指导。该工作组由 9 名儿科风湿病专家、2 名成人风湿病专家、2 名儿科心脏病专家、2 名儿科传染病专家和 1 名儿科重症监护医师组成。针对与 MIS-C 和 COVID-19 过度炎症相关的临床问题的初步声明是根据证据报告制定的。共识是通过修改后的 Delphi 流程建立的，其中涉及 2 轮匿名投票和 2 场网络研讨会。采用 9 分制来确定每个陈述的适当性（中位数为 1-3 分表示不适当，4-6 分表示不确定，7-9 分表示适当），并根据投票在数字范围内的分散情况将共识评级为低、中或高。批准的指导声明是那些被归类为适当的、具有中等或高度共识的声明，如投票前预先指定的。结果 ACR 工作组总共批准了 128 项指导声明，涉及儿科 COVID-19 中 MIS-C 和过度炎症的管理。这些陈述被细化为 40 份最终临床指导陈述，并附有描述 MIS-C 诊断路径的流程图。结论 我们对儿科人群中 SARS-CoV-2 相关综合征的了解不断发展。这份“动态文件”中提供的指导反映了当前可用的证据以及专家意见，并将随着进一步证据的出现而进行修订。
Objective To provide guidance on the management of multisystem inflammatory syndrome in children (MIS-C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and to provide recommendations for children with hyperinflammation during coronavirus disease 2019 (COVID-19), the acute, infectious phase of SARS-CoV-2 infection. Methods A multidisciplinary task force was convened by the American College of Rheumatology (ACR) to provide guidance on the management of MIS-C associated with SARS-CoV-2 and hyperinflammation in COVID-19. The task force was composed of 9 pediatric rheumatologists, 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS-C and hyperinflammation in COVID-19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved 2 rounds of anonymous voting and 2 webinars. A 9-point scale was used to determine the appropriateness of each statement (median scores of 1-3 for inappropriate, 4-6 for uncertain, and 7-9 for appropriate), and consensus was rated as low, moderate, or high based on dispersion of the votes along the numeric scale. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, as prespecified prior to voting. Results The ACR task force approved a total of 128 guidance statements addressing the management of MIS-C and hyperinflammation in pediatric COVID-19. These statements were refined into 40 final clinical guidance statements, accompanied by a flow diagram depicting the diagnostic pathway for MIS-C. Conclusion Our understanding of SARS-CoV-2-related syndromes in the pediatric population continues to evolve. The guidance provided in this "living document" reflects currently available evidence, coupled with expert opinion, and will be revised as further evidence becomes available.