Multisystem Inflammatory Syndrome (MIS-C) Clinical Pathway — Emergency, ICU and Inpatient

Admission/Consultation Considerations for Patients with Suspected Patients MIS-C

Patients with Suspected MIS-C with Shock

Admission

Admit Covid patience or COVID Exposed Patient with AGP's with evidence of shock to a
Special Treatment Room
For precautions guidance, refer to Precautions and Inpatient COVID-19 Pathway

Consults

The following consults are recommended for all patients requiring ICU level care.
- Infectious diseases – please consult prior to giving IVIG or steroids
- Rheumatology
- Discuss all cases with cardiology to facilitate echo and follow-up planning, formal consult for patients with EKG abnormalities, arrhythmias, abnormal cardiac labs, coronary aneurysms, or definitive diagnosis of MIS-C
- Consider cardiology
- Consider Dysregulated immune response team (DIRT)
- Consider neurology if significant altered mental status, focal neurologic deficit, clinical concern for intracranial hypertension, neuroimaging and/or concern for seizure
- Consider ophthalmology to evaluate for papilledema if double vision or cranial nerve VI palsy, significant altered mental status, or other clinical concern for intracranial hypertension, or at the discretion of neurology.

Treatment Decisions

There is no known optimal treatment for MISC. Therapies that have been utilized most often include, IVIG, steroids, and IL-1 blockade, sometimes in combination.

There is no known optimal treatment for MISC. Therapies that have been utilized most often include supportive care alone, IVIG, steroids, and IL-1 blockade, sometimes in combination.

Therapeutic decisions for patients suspected MIS-C should be discussed between the inpatient treatment team and multidisciplinary consultants (e.g., ID and Rheumatology, DIRT whenever possible) following admission. These conversations will be expedited in the setting of critical illness. Virtual multidisciplinary rounds occur in the late afternoon on an ad hoc basis at the discretion of the on-service ID, rheumatology and primary teams, as well as other clinical consulting services as applicable.

Consider:

Cases Refractory to Initial Therapy

Discuss further treatment with the multidisciplinary team (e.g., rheumatology, DIRT, ID).

Patients with Possible MIS-C without Shock

Admission

Admit to standard inpatient unit based on SARS-CoV-2 PCR Testing
For precautions guidance, refer to Precautions and Inpatient COVID-19 Pathway

Consults

Consults should be obtained on a case-by-case basis for patients on the inpatient unit but should be strongly considered in patients in whom MIS-C is suspected and for all patients in whom treatment is planned.
All patients:
- Infectious diseases – please consult prior to giving IVIG or steroids
- Rheumatology
- Discuss all cases with cardiology to facilitate echo and follow-up planning, formal consult for patients with EKG abnormalities, arrhythmias, abnormal cardiac labs, coronary aneurysms, or definitive diagnosis of MIS-C
Consider:
- Dysregulated immune response team (DIRT)
- Consider neurology if significant altered mental status, focal neurologic deficit, clinical concern for intracranial hypertension, neuroimaging and/or concern for seizure
- Consider ophthalmology to evaluate for papilledema if double vision or cranial nerve VI palsy, significant altered mental status, or other clinical concern for intracranial hypertension, or at the discretion of neurology.

Treatment Decisions

There is no known optimal treatment for MISC. Therapies that have been utilized most often include IVIG, steroids, and IL-1 blockade, sometimes in combination.

Therapeutic decisions for patients suspected MIS-C should be discussed between the inpatient treatment team and multidisciplinary consultants (ID and Rheumatology) following admission. These conversations will be expedited in the setting of critical illness. Virtual multidisciplinary rounds occur in the late afternoon on an ad hoc basis at the discretion of the on-service ID, rheumatology and primary teams, as well as other clinical consulting services as applicable.

Consider:

Cases Refractory to Initial Therapy

Discuss further treatment with the multidisciplinary team (e.g., rheumatology, DIRT, ID).

©2020 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.