Table 2.
Recommendations for diagnostic work-up in children evaluated for PIMS-TS.
|
Baseline investigations in a febrile child with features of PIMS-TS (according to disease severity, for a child in shock baseline and supplementary investigations should be carried out at the same time) |
Full blood count (FBC) C-reactive protein (CRP) Urea, creatinine, electrolytes (U&E) Liver function tests (LFTs) In addition, as clinically indicated:– Blood cultures (always before starting antibiotics)– Urine microscopy and culture– Lumbar puncture, if no contraindication present– NPA: respiratory panel, SARS-CoV-2 PCR |
|
Supplementary investigations in case of suspected PIMS-TS (in addition to baseline investigations) |
Blood gas, lactate, glucose Erythrocyte sedimentation rate (ESR) Coagulation: INR, aPTT, Fibrinogen D-dimers Ferritin Albumin Troponin T NT-pro-BNP LDH CK, and CK-MB SARS-CoV-2 serology Store serum (always before starting IVIG) Store EDTA 12-lead ECG and echocardiography Chest radiograph Abdominal ultrasound (if gastrointestinal symptoms) |
|
Other optional extended investigations (according to clinical presentation after MDT discussion. Those should NOT delay seeking expert opinion or treatment) |
EBV/CMV/Adeno-/Enterovirus blood PCR and consider other viral PCRs Stool virology/microbiology IL-10, IL-6 Triglycerides sCD25* *consider full HLH screen if suggestive features present (e.g., splenomegaly, fibrinogen normal or low; ferritin >2,000 μg/l): Perforin-, SAP-, and XIAP-expression, NK cell degranulation and consider HLH-directed therapy (MDT) |
| Repeat investigations: |
Critical patient (deteriorating and/or in PICU): Approx. 24 hourly: FBC, CRP, U&E, LFTs, coagulation, ferritin Other parameters guided by clinical progress Cardiac biomarkers, echocardiography in consultation with cardiology, ECG Non-critical patient with ongoing pyrexia: 24–48 hourly: FBC, CRP U&E, LFTs, ferritin *as above Echocardiography 48 hourly (in consultation with cardiology) Child improving ± defervescence: 48 hourly or pre-discharge: FBC, CRP, U&E, LFTs, ESR Consultation with cardiology prior to discharge |
Where possible, PIMS-TS patients should be enrolled in observational or interventional studies, which may include additional diagnostics.
*
Children with evidence of cardiac involvement should be discussed with a tertiary center for cardiology involvement and care in PICU should be considered.