Description:

Preliminary case definition Children and adolescents 0–19 years of age with measured or self-reported fever ≥ 3 days AND two or more of the following: a) Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet) b) Hypotension or shock c) Features of myocardial dysfunction, or pericarditis, or valvulitis, or coronary abnormalities (clinical features, ECHO findings, or laboratory markers such as elevated Troponin/NT-proBNP) d) Evidence of coagulopathy (such as abnormal PT, PTT, elevated d-Dimers) e) Acute gastrointestinal problems (such as diarrhoea, vomiting or abdominal pain) AND Elevated markers of inflammation such as ESR, C-reactive protein or procalcitonin AND No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes AND Evidence of current or previous COVID-19 (RT-PCR, antigen test or serology positive) or likely contact with patients with COVID NB Consider this syndrome in children with features of typical or atypical Kawasaki disease or toxic shock syndrome. Based on CRF on https://isaric.org/research/covid-19-clinical-research-resources/multisystem-inflammatory-syndrome-mis-c/ This Case Report Form (CRF) has been developed by ISARIC in cooperation with WHO's working group (https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19) to use as a standalone CRF for children and adolescents presenting with syndrome of suspected Multisystem Inflammatory Syndrome (MIS-C). This Module is to be completed at time of discharge or death.

Link:
https://isaric.org/research/covid-19-clinical-research-resources/multisystem-inflammatory-syndrome-mis-c/
Keywords:
Versions (1)
  1. 8/11/21 8/11/21 -
Copyright Holder:
ISARIC on behalf of Oxford University
Uploaded on:

August 11, 2021

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Creative Commons BY-SA 4.0
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Multisystem inflammatory syndrome (MIS) in children and adolescents temporally related to COVID-19

English
Details

MODULE 2: OUTCOME CASE REPORT FORM

1 forms  
Participant Identification
Summary of clinical features of current illness (include all signs identified any time between admission and discharge/death)
Fever
°C
F
days
days
Rash
Bilateral conjunctivitis
Oral mucosal inflammation signs
Peripheral cutaneous inflammation signs (hands or feet)
Hypotension (age appropriate)
Tachycardia (age appropriate)
Prolonged capillary refill time
Pale/motted skin
Cold hands/feet
Urinary output <2mL/kg/hr
Chest pain
Tachypnoea (age appropriate)
Respiratory distress
Abdominal pain
Diarrhoea
Vomiting
Other clinical features
Laboratory results (record the most abnormal result during the hospital admission up to the time of discharge/death) (*record units if different from those listed)
g/L
Haemoglobin (g/L) measurement not done?
x10^9/L
Total WBC count (x10^9/L) not done?
x10^9/L
Neutrophils (x10^9/L) measurement not done?
x10^9/L
Lymphocytes (x10^9/L) measurement not done?
%
Haematocrit (%) measurement not done?
x10^9/L
Platelets (x10^9/L) measurement not done?
APTT/APTR measurement not done?
sec
PT (seconds) measurement not done?
INR measurement not done?
g/L
Fibrinogen (g/L) measurement not done?
ng/mL
Procalcitonin (ng/mL) measurement not done?
mg/L
CRP (mg/L) measurement not done?
mm/hr
ESR (mm/hr) measurement not done?
mg/L
D-Dimer (mg/L) measurement not done?
pg/mL
IL-6 (pg/mL) measurement not done?
pg/mL
IL-10 (pg/mL) measurement not done?
umol/L
Creatinine (umol/L) measurement not done?
mmol/L
Sodium (mmol/L) measurement not done?
mmol/L
Potassium (mmol/L) measurement not done?
mmol/L
Urea (BUN) (mmol/L) measurement not done?
mmol/L
Glucose (mmol/L) measurement not done?
pg/mL
Pro-BNP (pg/mL) measurement not done?
ng/mL
Troponin (ng/mL) measurement not done?
U/L
Creatine kinase (U/L) measurement not done?
U/L
LDH (U/L) measurement not done?
Triglyceride measurement not done?
U/L
ALT/SGPT (U/L) measurement not done?
umol/L
Total bilirubin (umol/L) measurement not done?
U/L
AST/GOT (U/L) measurement not done?
g/dL
Albumin (g/dL) measurement not done?
mmol/L
Lactate (mmol/L) measurement not done?
ng/mL
Ferritin (ng/mL) measurement not done?
Imaging and pathogen testing (include the most abnormal results from admission up to the time of discharge/death)
Chest X-ray performed
Chest CT performed
If yes, were infiltrates present?:
Echocardiography performed?
On that echocardiogram were there: features of myocardial dysfunction?
On that echocardiogram were there: features of pericarditis?
On that echocardiogram were there: features of valvulitis?
On that echocardiogram were there: features of coronary abnormalities?
ECG performed?
Other cardiac imaging performed?
Bacterial pathogen
SARS-CoV-2 testing, RT-PCR
SARS-CoV-2 testing, rapid antigen test
SARS-CoV-2 testing, rapid antibody test
SARS-CoV-2 testing, ELISA
SARS-CoV-2 testing, Neutralization test
Other test?
Other viral pathogen
If no pathogen testing: clinically diagnosed COVID-19?
Treatment: at any time during the hospital admission, did the patient receive any of the following:
Oral / orogastric fluids?
Intravenuous fluids?
Antiviral?
If yes, Ribavirin?
If yes, Lopinavir/Ritonavir?
If yes, Neuraminidase inhibitor?
If yes, Tocilizumab?
If yes, Anakinra?
If yes, Ivermectin?
If yes, Interferon alpha?
If yes, Interferon beta?
If yes, Remdesivir?
Corticosteroid (not topical)?
If yes, specify route
days
Duration: unknown
IV immune globulin?
days
days
Antibiotic?
days
Duration: unknown
Antifungal agent?
Supportive care
ICU or high dependency unit admission?
days
Oxygen supplementation therapy?
If yes, max O2 flow
If yes, interface
Prone positioning
days
Non-invasive ventilation (any e.g. BiPAP/CPAP)
If yes, prone position?
days
Invasive ventilation (any)?
cm H2O
%
cm H2O
days
Inotropes/Vasopressors?
Extracorporal (ECMO) support
days
Plasma exchange?
HFOV
Blood transfusion
Renal replacement therapy (RRT) or dialysis?
days
Outcome
Please select only one outcome
Outcome date: unknown
If discharged alive: care needs at discharge versus before illness
What was the physician's impression of the final diagnosis? Multisystem inflammatory syndrome
Kawasaki disease
Atypical kawasaki disease
Toxic shock syndrome
Were there any sequelae present at the time of discharge:
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