Specialty follow -up care after hospital discharge of patients with multisystem inflammatory syndrome in children associated with COVID-19 from a rural tertiary-care hospital.

Abstract

The clinical features of Multisystem Inflammatory Syndrome in Children (MIS-C) have been well documented, but there is limited data regarding the short term and longitudinal outcomes of children living in rural areas. We report the demographic and clinical features, as well as the multi-specialty follow-up of patients with MIS-C served by a large tertiary care rural health system. Patients that met the Centers for Disease Control (CDC) case definition of MIS-C admitted between March 1, 2020, and March 31, 2021, were included in this case series. Manual chart review was used to report demographic characteristics, clinical, laboratory and radiologic features during acute hospitalization and multispecialty follow-up, and adherence to follow-up 6-10 weeks after hospital discharge. Twenty-one patients with MIS-C were admitted at our center during the review period. Ninety percent of the cohort required intensive care during hospitalization. Of 19 patients with measured ejection fractions, 52% had some degree of left ventricular dysfunction on admission; nine patients had electrocardiogram changes on admission. The majority of patients had elevated inflammatory markers during hospitalization. Most patients had resolution of symptoms, improvement in inflammatory markers, and normal cardiac function at the time of discharge. Follow-up with pediatric cardiology, hematology-oncology and infectious disease was indicated for most patients at discharge. Of these, 100% of patients kept initial follow-up appointments with pediatric cardiology and infectious disease, while 94% kept initial follow-up appointments with pediatric hematology-oncology. Though most patients were critically ill during hospitalization, the majority had resolution of cardiac abnormalities and inflammatory markers at discharge and timely follow-up with multiple subspecialists after admission with MIS-C.