Cardiac Point-of-Care Ultrasound Findings in Multisystem Inflammatory Syndrome in Children in the Pediatric Emergency Department.

Abstract

Objectives: Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening condition associated with cardiac involvement. Cardiac point-of-care ultrasound (POCUS) can be performed at the bedside in the pediatric emergency department (PED) to identify cardiac pathology. There is limited data on cardiac POCUS findings in children with MIS-C in the PED. The main outcome objective of our study was to describe the cardiac POCUS findings in MIS-C patients in the PED.

Methods: This is a multicenter, retrospective, cohort study between February 15, 2021 and March 31, 2022, during the alpha, delta, and omicron severe acute respiratory syndrome coronavirus 2 waves in 6 PEDs in Israel. We included patients diagnosed with MIS-C who received a cardiac POCUS examination in the PED. All POCUS clips were analyzed by a PED POCUS expert.

Results: We included 32 MIS-C patients who underwent cardiac POCUS during the study period. The median age was 8 years (interquartile range = 6 to 10 y), and 20 (63%) were males. The median time from onset of symptoms upon PED visit was 5 days (interquartile range = 4 to 5 d). Overall, 27 patients (84%) were diagnosed with normal cardiac function and 5 patients with decreased cardiac function (16%). No patients were diagnosed with pathologic cardiac effusion. Three patients were diagnosed with plethoric inferior vena cava. Among the patients, 17 (53%) were admitted to the pediatric wards and 15 (47%) to the pediatric intensive care unit. There was no mortality.

Conclusion: Cardiac POCUS by PEM physicians is an applicable tool for the evaluation of MIS-C patients in the PED. In our study, 16% of MIS-C patients who underwent POCUS had decreased cardiac function per POCUS on their PED presentation. Future studies are needed to evaluate the impact of cardiac POCUS in the PED of patients with MIS-C.