(26) Impact of Multisystem Inflammatory Syndrome in Children (MIS-C) in a Rural Integrated Health System

Ariadne I. Trautman, University of South Dakota, Sanford School of Medicine, Yankton, SD, United States; Ashlesha Bagwe, University of South Dakota, Sanford School of Medicine, United States; Santiago M.C. Lopez, Sanford Children's Hospital, United States

Background: In April 2020, several clusters of children presenting with hyperinflammatory shock associated with COVID-19 infection were identified by clinicians, leading to the CDC releasing a health advisory to report on cases meeting multisystem inflammatory syndrome in children (MIS-C) criteria. The diagnosis and treatment of MIS-C can be impacted by the healthcare setting the child is evaluated in. In the rural United States, access to healthcare services, especially pediatric intensive care, is affected by large distances and lower patient volumes.

Objectives: This study aims to characterize trends in patient demographics, clinical presentation, laboratory and imaging data, and clinical outcomes in MIS-C patients in a rural healthcare network.

Design/Methods: This study is a retrospective chart review of patients hospitalized between August 2020 and May 2021 with the diagnosis of MIS-C in a rural health system in the Upper Midwest. Patient records were reviewed to determine demographics, clinical presentation, laboratory and imaging studies, therapeutic interventions, outcomes, and follow-up data.

Results: The median age was 8 years old, predominantly males. Overall 36% (n=8) of the cohort were obese. All subjects had fever; the median length was 6 days. There was marked elevation in inflammatory and cardiac laboratory markers. On echocardiogram, 4 subjects (18.18%) were found to have low ejection fraction and 3 subjects (13.63%) had pericardial effusion. All subjects were treated with steroid therapy and 20 (91%) also received IVIG therapy. 12 (54%) subjects were admitted to the ICU. Three (14%) subjects required oxygen supplementation and none required intubation. All subjects had resolution of symptoms at follow-up. All follow-up echocardiograms and Cardiac MRIs were normal.

Conclusion: Clinically, the presentation of MIS-C has similarities to Kawasaki’s disease, with long-lasting high fevers and multiorgan involvement. Cardiac involvement often consisted of reduced ejection fraction that resolved upon follow-up. Notable trends in laboratory studies were the elevation of Troponin, D-dimer, BNP, CRP, ESR, Ferritin, and Procalcitonin. Treatment was focused on targeting immune dysregulation rather than viral replication. Longitudinal follow-up data revealed symptom resolution and laboratory value normalization. Overall, this report contributes to the descriptive literature on MIS-C by characterizing risk factors, clinical picture, treatments, and outcomes in a rural integrated healthcare network.