Assessing pattern of the pediatric multisystem inflammatory syndrome (PMIS) in children during COVID-19 infection: Experience from the emergency department of a LMICs tertiary care hospital.

Abstract

Abstract Background Pediatric multisystem inflammatory syndrome (PMIS) is a hyperinflammatory syndrome with multi organ involvement. In children, severe complications were reported with features similar to incomplete Kawasaki disease during later phases of COVID- 19 infection. Objectives This study aimed to determine the frequency, pattern of presentation, and significant laboratory parameters related to PMIS in children presenting to the emergency department during COVID − 19. Method This was a prospective observational study. Children (1 month − 16 years) with symptoms suggestive of PMIS were included. A predesigned questionnaire was used to collect data on demographics, presenting complaints, performing investigations, offering treatment, and the outcome during the emergency stay. Besides using descriptive statistics, the Mann-Whitney U test compared the in-hospital mortality with triage vitals to see any significant differences between Alive and Expired. The Chi-square test or Fisher exact test was used for categorical data to see the association. Result 56 patients, majority male (85.7%), were diagnosed with the pediatric multisystem inflammatory syndrome with a mean age of 7.67 ± 4.8 (ranging from 1 to 16 years). COVID PCR was positive in only 18% (10) patients, whereas COVID antibodies were positive in 78.6% (44). The main presenting complaints were related to respiratory 70% followed by neurological 57% and Gastrointestinal 54% with the common clinical sign of delayed capillary refill time (93%) and low volume pulses (89%). Out of 12 patients with negative COVID antibodies, 10(83.3%) patients tested PCR positive, whereas only 2 (16.7%) patients had both antibody body and PCR negative. Based on the multivariate binary regression model indicated that the risk for mortality was higher in patients with ED Stay of more than 4 Hours (OR = 5.4), a total hospital stays of more than five days (OR = 0.17, 95% CI: 0.02 to 0.64). Conclusion Most children with PMIS were found to have positive antibodies against COVID-19. An increased ED stay was associated with poor outcomes.