Figure 1.

Diagnostic pathway for multisystem inflammatory syndrome in children (MIS-C). Moderate-to-high consensus was reached by the Task Force in the development of this diagnostic pathway for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2). ¹An epidemiologic link to SARS–CoV-2 infection is defined as a child with any of the following criteria: positive for SARS–CoV-2 by polymerase chain reaction (PCR), positive for SARS–CoV-2 by serology, preceding illness resembling coronavirus disease 2019 (COVID-19), or close contact with an individual with confirmed or suspected COVID-19 in the past 4 weeks. ²Suggestive clinical features include rash (polymorphic, maculopapular, or petechial, but not vesicular), gastrointestinal symptoms (diarrhea, abdominal pain, or vomiting), oral mucosal changes (red and/or cracked lips, strawberry tongue, or erythema of the oropharyngeal mucosa), conjunctivitis (bilateral conjunctival infection without exudate), and neurologic symptoms (altered mental status, encephalopathy, focal neurologic deficits, meningismus, or papilledema). ³The complete metabolic panel (CMP) includes measurement of sodium, potassium, carbon dioxide, chloride, blood urea nitrogen, creatinine, glucose, calcium, albumin, total protein, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin. ⁴Procalcitonin, cytokine panel, and blood smear test results should be sent, if available. ⁵Serologic test results should be sent if not sent in tier 1 evaluation, and if possible, SARS–CoV-2 IgG, IgM, and IgA test results should be sent. CRP = C-reactive protein; ESR = erythrocyte sedimentation rate; ALC = absolute lymphocyte count; CBC = complete blood cell count; BNP = B-type natriuretic peptide; PT = prothrombin time; PTT = partial thromboplastin time; LDH = lactate dehydrogenase; u/a = urinalysis; EKG = electrocardiogram.