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. Retropsective Cohort Review of MIS-C Patients, Lancet, 2021