448 - Improving Time to Intervention in Patients with Multisystem Inflammatory Syndrome in Children Using Point-of-Care Ultrasound in the Emergency Department

Poster Number: 448
Publication Number: 448.312

Amy Dutko, Texas Children's Hospital, Houston, TX, United States; Kiyetta Alade, Baylor College of Medicine, Houston, TX, United States; Alan Riley, Baylor College of Medicine, Houston, TX, United States; Elizabeth A. Camp, Baylor College of Medicine, Houston, TX, United States; Tiphanie Vogel, Baylor College of Medicine, Houston, TX, United States; Eyal Muscal, Baylor College of Medicine, houston, TX, United States; Stephanie K. Leung, Baylor College of Medicine, Houston, TX, United States

Background: Multisystem inflammatory syndrome in children (MIS-C) is an inflammatory condition which can lead to cardiac dysfunction and critical illness weeks after a COVID-19 infection. Early recognition of cardiac dysfunction is crucial in the management of these children. Point-of-care ultrasound (POCUS) is a tool frequently used in the emergency department (ED) and intensive care unit to identify cardiac dysfunction and assist in the management of shock. While broad descriptions of POCUS findings have been reported in children with MIS-C, specific outcomes in children who received a cardiac POCUS have not been well described. 

Objective: We hypothesized that cardiac POCUS use would expedite diagnosis of cardiac dysfunction when present and shorten time to interventions in MIS-C patients.

Design/Methods: A retrospective cohort study was conducted at a quaternary care pediatric ED and a community site from Feb. 1, 2020 - March 31, 2021 and included all children aged 0-21 years presenting with MIS-C. Suspected MIS-C was defined by 2020 CDC criteria as a recent COVID-19 infection plus fever, gastrointestinal symptoms, or Kawasaki Disease-like symptoms (rash, conjunctivitis, lymphadenitis, and/or extremity edema). Age, duration of symptoms, organ dysfunction when present, and lab findings were recorded. Patients with MIS-C who had an ED POCUS were compared to those who did not. Outcomes of ED and hospital length of stay (LOS), time to disposition from the ED, a rapid response call to assess the need for higher level of care or transfer within 24 hours of admission, time to POCUS and standard echocardiography, time to administration of medications, extracorporeal membrane oxygenation (ECMO) use, and survival rate were evaluated.

Results: During the study period, 198 MIS-C patients met inclusion criteria including 101 (51%) who received a POCUS and 97 (49.0%) who did not. Demographic data and symptoms were similar in both groups. When adjusted for acuity, elevated troponin, and ferritin, time to interventions of echocardiography, epinephrine administration, and immunomodulator (anakinra, steroids, and IVIG) administration were all significantly improved in patients who received an ED POCUS.

Conclusion(s): POCUS is helpful in identifying children with cardiac dysfunction in the ED including those with MIS-C. When POCUS was performed in children with suspected MIS-C, these patients had improved time to interventions including standard echocardiography and both pressor and immunomodulatory medication administration.