Multisystem Inflammatory Syndrome (MIS-C) Clinical Pathway — Emergency, ICU and Inpatient

Discharge Criteria, Instructions and Follow-up Plan
Discharge criteria will vary depending on the clinical scenario and severity of presenting illness, but generally include include lack of fever for 48 hours without antipyretics (excluding steroids), improvement in the presenting clinical symptoms (e.g., diarrhea, rash, etc) and/or improvement in lab markers. Criteria for discharge should be discussed with services seeing the patient in follow up (e.g., rheumatology, cardiology, and infectious diseases).
Aspirin (ASA)	Low-dose ASA should be continued until directed by Cardiology Patients with coronary abnormalities may require prolonged use of ASA Avoid NSAIDS while on ASA
Steroids, if received inpatient	2-3 week oral prednisolone/prednisone taper after initial treatment Suggested taper: 2mg/kg/day div BID x 5 days, 1 mg/kg/day div BID x 5 days, 0.5 mg/kg/day DAILY x 5 days
Outpatient follow-up	PCP Follow up within 2-3 days Cardiology Follow up in approximately two weeks. Significant coronary findings or ventricular dysfunction may require earlier follow-up and more frequent echocardiograms. Rheumatology Follow up in 2 weeks. Obtain CBC, CMP, CRP, ferritin, d-dimer, troponin, BNP, fibrinogen prior to appointment ID Follow up in 4 weeks All appointments should be made before discharge, if possible.
Reasons to return to ED	Fever > 38.0°C, recurrence of presenting symptoms, or new appearance of respiratory distress, before follow-up with Cardiology or Rheumatology. After cardiology/rheumatology follow-up reasons for return to medical care should be discussed with these services.
Vaccines	No live vaccines x 11 months if IVIG was administered During flu season: flu shot prior to discharge if not already received
COVID Vaccination	Pts w/ history of MIS-C may choose to be vaccinated Vaccination should be deferred until the patient has recovered clinically from MIS-C, including return to normal cardiac function and after the cardiology follow up visit. Because risk of reinfection is low in the months after SARS-CoV-2 infection, individuals should consider delaying vaccination for 90 days after diagnosis of MIS-C. Case-by-case discussions surrounding post-MIS-C vaccination can occur during the ID clinic follow up visit. Penner J, et al. Retrospective Cohort Review of MIS-C Patients, Lancet, 2021

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.