Table 2. Demographics and Clinical Features of the PIMS-TS Cohort.
| Characteristic | No. (%)a | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| All PIMS-TS cases (n = 58)b | Febrile and inflammatory (n = 23)c | Stratification by shockd | Stratification by Kawasaki diseasee | Stratification by Kawasaki clinical criteriae | Stratification by coronary artery aneurysmf | Stratification by evidence of SARS-CoV-2 infectiong | ||||||
| Shock present (n = 29) | Shock absent (n = 29) | Kawasaki disease (n = 13) | Not Kawasaki disease (n = 45) | Criteria met (n = 7) | Criteria not met (n = 51) | Present (n = 8) | Absent (n = 50) | Positive (n = 45) | Negative (n = 13) | |||
| Age, median (IQR), y | 9 (5.7-14) | 10 (5.5-14) | 10.5 (7-14) | 10 (3-14) | 8 (5-11) | 10.5 (5.7-14) | 6 (2-8) | 10 (6-14) | 9.5 (8-12.3) | 9 (5-11) | 10 (6-14) | 7 (2.5-14) |
| Sex | ||||||||||||
| Male | 38 (66) | 17 (74) | 16 (55) | 22 (76) | 10 (77) | 28 (62) | 6 (86) | 32 (63) | 6 (75) | 32 (64) | 30 (67) | 8 (61) |
| Female | 20 (34) | 6 (26) | 13 (45) | 7 (24) | 3 (23) | 17 (38) | 1 (14) | 19 (37) | 2 (25) | 18 (36) | 15 (33) | 5 (39) |
| Race/ethnicity | ||||||||||||
| Black | 22 (38) | 7 (30) | 14 (48) | 8 (28) | 8 (62) | 14 (31) | 2 (29) | 20 (39) | 7 (88) | 15 (30) | 18 (40) | 4 (31) |
| Asian | 18 (31) | 6 (26) | 6 (21) | 6 (21) | 0 | 12 (27) | 0 | 12 (24) | 0 | 12 (24) | 11 (24) | 1 (8) |
| White | 12 (21) | 8 (35) | 6 (21) | 12 (42) | 4 (31) | 14 (31) | 4 (57) | 14 (27) | 1 (13) | 17 (34) | 13 (29) | 5 (38) |
| Otherh | 6 (10) | 2 (9) | 3 (10) | 3 (10) | 1 (8) | 5 (11) | 1 (14) | 5 (10) | 0 | 6 (12) | 3 (7) | 3 (23) |
| Clinical features at presentationi | ||||||||||||
| Abdominal pain | 31 (53) | 13 (57) | 18 (62) | 13 (45) | 2 (15) | 29 (64) | 1 (14) | 30 (59) | 2 (33) | 29 (58) | 24 (55) | 7 (50) |
| Diarrhea | 30 (52) | 10 (44) | 19 (66) | 11 (38) | 7 (54) | 23 (51) | 2 (29) | 28 (55) | 6 (75) | 24 (48) | 25 (75) | 5 (36) |
| Rash | 30 (52) | 9 (39) | 15 (50) | 15 (50) | 10 (77) | 20 (44) | 7 (100) | 23 (45) | 5 (63) | 25 (50) | 21 (48) | 9 (64) |
| Shockd | 29 (50) | 0 | 29 (100) | 0 | 6 (46) | 23 (51) | 1 (14) | 28 (55) | 6 (75) | 23 (46) | 25 (56) | 4 (31) |
| Vomiting | 26 (45) | 10 (44) | 15 (52) | 11 (38) | 5 (38) | 21 (47) | 2 (29) | 24 (47) | 5 (63) | 21 (42) | 20 (45) | 6 (43) |
| Conjunctival injection | 26 (45) | 9 (39) | 11 (38) | 15 (52) | 11 (85) | 15 (33) | 7 (100) | 19 (37) | 5 (63) | 21 (42) | 20 (45) | 6 (43) |
| Mucous membrane changes | 17 (29) | 5 (22) | 6 (21) | 11 (38) | 6 (46) | 11 (24) | 6 (86) | 11 (22) | 1 (13) | 16 (32) | 11 (25) | 6 (43) |
| Headache | 15 (26) | 4 (17) | 11 (38) | 4 (14) | 4 (31) | 11 (24) | 1 (14) | 14 (27) | 4 (50) | 11 (22) | 13 (30) | 2 (14) |
| Respiratory symptoms | 12 (21) | 2 (13) | 9 (31) | 3 (10) | 3 (23) | 9 (20) | 1 (14) | 11 (22) | 3 (38) | 9 (18) | 9 (20) | 3 (21) |
| Lymphadenopathy | 9 (16) | 3 (13) | 2 (7) | 7 (24) | 5 (38) | 4 (9) | 4 (57) | 5 (10) | 2 (33) | 7 (14) | 8 (18) | 1 (7) |
| Swollen hands and feet | 9 (16) | 2 (13) | 4 (14) | 5 (17) | 4 (31) | 5 (11) | 4 (57) | 5 (10) | 1 (13) | 7 (14) | 7 (16) | 2 (14) |
| Sore throat | 6 (10) | 1 (4) | 5 (17) | 1 (3) | 0 | 6 (13) | 0 | 6 (12) | 1 (13) | 5 (10) | 6 (14) | 0 |
| Confusion | 5 (9) | 0 | 5 (17) | 0 | 1 (8) | 4 (9) | 0 | 5 (10) | 1 (13) | 4 (8) | 5 (11) | 0 |
Abbreviations: IQR, interquartile range; PIMS-TS, pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Clinical features are listed in order of frequency. In addition, pairwise comparison is included dividing the cohort by febrile and inflammatory, shock, Kawasaki disease, clinical diagnostic criteria of Kawasaki, presence of coronary artery aneurysm, and laboratory evidence for SARS-CoV-2 infection.
Fever >38 °C for >72 hours was an entry point to the study.
Febrile and inflammatory only: this cohort of children were those who did not meet the criteria for shock (footnote d) or the clinical diagnostic criteria for Kawasaki disease (footnote e).
Shock was defined as needing inotrope support or fluid resuscitation >20 mL/kg.
American Heart Association criteria for the definition of Kawasaki disease is to have persistent fever and 4 of the following 5 mucocutaneous features: erythema and cracking of lips, strawberry tongue, and/or erythema of oral and pharyngeal mucosa; bilateral bulbar conjunctival injection without exudate; rash (maculopapular, diffuse erythroderma); erythema and edema of the hands and feet in acute phase and/or periungual desquamation in subacute phase; and cervical lymphadenopathy (>1.5 cm diameter). Patients with fewer than 4 features were stratified as having Kawasaki disease if coronary artery aneurysms were present. In the absence of coronary artery changes, stratification by Kawasaki clinical criteria required 4 of 5 features to be present.
Coronary artery aneurysm is dilatation of any coronary artery seen on echocardiogram with a z score of >2.0 in the acute phase.
SARS-CoV-2 infection includes positive SARS-CoV-2 polymerase chain reaction or positive SARS-CoV-2 IgG serology results.
Other includes those of mixed race/ethnicity, Middle Eastern, or other ethnicity (https://www.ethnicity-facts-figures.service.gov.uk/ethnic-groups).
Presentation refers to the admission clerking to hospital, for example, the point at which the patient was considered to have a potential diagnosis of PIMS-TS.