199 - CREATION OF PREDICTION TOOL TO GUIDE FURTHER WORKUP OF FEBRILE CHILDREN IN THE EMERGENCY DEPARTMENT UNDER CONSIDERATION FOR MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C)

Background

Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of COVID-19 in children that can difficult to distinguish from KD. Its workup necessitates extensive laboratory investigations. This project sought to provide pediatric acute care providers with a data-based tool to guide further decision-making during initial workups for children under consideration for MIS-C.

Methods

We compared documented physical findings and laboratory data (inflammatory markers, electrolytes, and liver function tests) from MIS-C cases (n=46) to control data extracted from a pre-pandemic database of febrile children (n=70), including 26 with KD. Significant findings on Fisher’s exact test and independent t-tests were used to develop a clinical score. Receiver operator curve (ROC) analysis was performed to assess this scoring system using two different cohorts of MIS-C.  

Results

From initial comparative analysis, a score (³ 3) utilizing levels of CRP, lymphocytes, platelets, and total white blood cells was developed.  ROC curve analysis demonstrated excellent parameters, with overall negative predictive value (NPV) of 97.62%. In children < 9 years old, the score had an NPV of 98.21% and in ³ 9 years old, the score demonstrated a NPV of 100.00%. We validated the score on a geographically disparate cohort by showing a NPV of 89.13% of all children and 95.35% in children ³ 2 years of age.

Conclusion

Use of this scoring system based on readily available laboratory values can eliminate many febrile children from consideration of MIS-C allowing front-line providers to focus more extensive laboratory evaluations and extended observation on fewer children with a higher likelihood of having MIS-C.