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

Isolation Precautions

MIS-C is an immune-mediated, post-infectious phenomenon. Presence of the inflammatory symptoms described alone should therefore NOT prompt placement on expanded or modified expanded precautions, unless SARS-CoV-2 PCR testing is positive or pending.

Base precautions on clinical symptoms and results of SARS-CoV-2 PCR testing (NOT antibody testing).

Note that since this syndrome overlaps with other transmissible infections, patients may require transmission-based precautions for other indications (for example, adenovirus).

Positive SARS-CoV-2 PCR Anterior nares swab or tracheal aspirate	Anterior nares swab or tracheal aspirate Expanded/modified expanded per the Inpatient COVID-19 Pathway
Negative SARS-CoV-2 PCR NP or tracheal aspirate	Standard precautions, except as below: Diarrhea present: contact precautions per usual practice Alternative infectious disease diagnosis suspected/confirmed Usual IPC transmission-based precautions for suspected pathogen For example: Adenovirus, meningococcemia
Positive SARS-CoV-2 serology with negative PCR Testing	Standard precautions or Transmission-based precautions for other suspected or confirmed infectious process.

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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.