Table 2.

Diagnostic evaluation of MIS-C^*

Guidance statement	Level of consensus
The vast majority of children with COVID-19 present with mild symptoms and have excellent outcomes. MIS-C remains a rare complication of SARS-CoV-2 infections.	High
MIS-C is temporally associated with SARS-CoV-2 infections. Therefore, the prevalence of the virus in a given geographic location, which may change over time, should inform management decisions.	Moderate
The approach to testing for SARS-CoV-2 infections will evolve over the course of the COVID-19 pandemic, and it is therefore important to consider up-to-date testing methods and the prevalence of viral transmission in the community.	Moderate
A child “under investigation” for MIS-C should also be evaluated for other possible infections and non-infection-related conditions (e.g., malignancy) that may explain the clinical presentation.	High
Patients “under investigation” for MIS-C may require additional diagnostic studies (not described in Figure 1), including, but not limited to, imaging of the chest, abdomen, and/or central nervous system and lumbar puncture.	High
Outpatient evaluation for MIS-C may be appropriate for assessing well-appearing children with stable vital signs and for ensuring that physical examinations provide close clinical follow-up.	Moderate
Patients “under investigation” for MIS-C should be considered for admission to the hospital for further observation while the diagnostic evaluation is completed, especially if the patient displays any of the following symptoms:  1. abnormal vital signs (tachycardia, tachypnea);  2. respiratory distress of any severity;  3. neurologic deficits or change in mental status (including subtle manifestations);  4. evidence of even mild renal or hepatic injury;  5. marked elevations in inflammation markers (CRP >10 mg/dl);  6. abnormal EKG findings or abnormal levels of BNP or troponin T.	Moderate to high
Patients presenting with shock, significant respiratory distress, neurologic changes (altered mental status, encephalopathy, focal neurologic deficits, meningismus, papilledema), dehydration, or features of KD should be admitted for further evaluation, regardless of MIS-C status, in accordance with standard of care.	High
Children admitted to the hospital with MIS-C should be managed by a multidisciplinary team that includes pediatric rheumatologists, cardiologists, infectious disease specialists, and hematologists. Depending on the clinical manifestations, other subspecialties may need to be consulted as well; these include, but are not limited to, pediatric neurology, nephrology, hepatology, and gastroenterology.	Moderate to high

^*MIS-C = multisystem inflammatory syndrome in children; COVID-19 = coronavirus disease 2019; SARS–CoV-2 = severe acute respiratory syndrome coronavirus 2; CRP = C-reactive protein; EKG = electrocardiogram; BNP = B-type natriuretic peptide; KD = Kawasaki disease.