{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T07:15:07Z","timestamp":1763968507582,"version":"3.40.4"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (\u22653 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg\/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4\u201312.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7\u20138.6), and platelet count less than 220,000\/uL (aOR, 4.2; 95% CI, 1.8\u20139.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg\/dL, lymphocyte percent more than 20%, and platelet count more than 260,000\/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66\u2013100], specificity 38% [95% CI, 22\u201355]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Serum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002914","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T16:02:24Z","timestamp":1677081744000},"page":"555-561","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Predicting Delayed Shock in Multisystem Inflammatory Disease in Children"],"prefix":"10.1097","volume":"39","author":[{"given":"Deborah A.","family":"Levine","sequence":"first","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian\/Weill Cornell Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Uy","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian\/Weill Cornell Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Krief","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hofstra-Northwell School of Medicine\/Cohen's Children's Medical Center, Queens"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cara","family":"Bornstein","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hofstra-Northwell School of Medicine\/Cohen's Children's Medical Center, Queens"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina","family":"Daswani","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital\/Westchester Medical Center Health Network, Valhalla, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darshan","family":"Patel","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital\/Westchester Medical Center Health Network, Valhalla, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marni","family":"Kriegel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Pediatrics, Hackensack University Medical Center\/Hackensack Meridian School of Medicine, Hackensack, NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazreen","family":"Jamal","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Pediatrics, NewYork-Presbyterian\/Columbia University Valegos College of Physicians and Surgeons"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavita","family":"Patel","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tian","family":"Liang","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Arroyo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Maimonides Medical Center, Brooklyn"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Strother","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Czer Anthoney","family":"Lim","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa L.","family":"Langhan","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven CT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameer","family":"Hassoun","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, NewYork-Presbyterian Queens\/Weill Cornell Medicine, Flushing"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haamid","family":"Chamdawala","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Jacobi Hospital Center\/North Central Bronx Hospital, The Bronx"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl Philip","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Waseem","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, Lincoln Medical Center\/Weill Cornell Medicine, The Bronx"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ee Tein","family":"Tay","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine\/Bellevue Hospital Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Mortel","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, Harlem Hospital Center, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam B.","family":"Sivitz","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, Newark Beth Israel Medical Center\/Children's Hospital of New Jersey, New Jersey Medical School, Rutgers University, Newark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, NewYork-Presbyterian\/Brooklyn Methodist Hospital, Brooklyn"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horton James","family":"Lee","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuqing","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Gorelik","sequence":"additional","affiliation":[{"name":"Pediatrics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shari L.","family":"Platt","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian\/Weill Cornell Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Dayan","sequence":"additional","affiliation":[{"name":"Emergency Medicine, NewYork-Presbyterian\/Columbia University Valegos College of Physicians and Surgeons, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1001\/jamapediatrics.2021.0630","article-title":"Trends in geographic and temporal distribution of US children with multisystem inflammatory syndrome during the COVID-19 pandemic","volume":"175","year":"2021","journal-title":"JAMA Pediatr"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem inflammatory syndrome in U.S. children and adolescents","volume":"383","year":"2020","journal-title":"N Engl J Med"},{"key":"bib6-20250504","first-page":"2001010","article-title":"SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020","volume":"25","year":"2020","journal-title":"Euro Surveill"},{"key":"bib7-20250504","first-page":"m2094","article-title":"Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study","volume":"369","year":"2020","journal-title":"BMJ"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1056\/NEJMoa2021756","article-title":"Multisystem inflammatory syndrome in children in New York state","volume":"383","year":"2020","journal-title":"N Engl J Med"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jemermed.2021.07.070","article-title":"Multisystem inflammatory syndrome in children","volume":"62","year":"2022","journal-title":"J Emerg Med"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ajem.2021.10.011","article-title":"Identifying pediatric patients with multisystem inflammatory syndrome in children presenting to a pediatric emergency department","volume":"51","year":"2022","journal-title":"Am J Emerg Med"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1161\/CIRCULATIONAHA.120.048360","article-title":"Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic","volume":"142","year":"2020","journal-title":"Circulation"},{"key":"bib12-20250504","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1136\/annrheumdis-2020-217960","article-title":"Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort","volume":"79","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"bib13-20250504","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1007\/s00246-020-02391-2","article-title":"Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital","volume":"41","year":"2020","journal-title":"Pediatr Cardiol"},{"key":"bib14-20250504","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S2352-4642(21)00050-X","article-title":"Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study","volume":"5","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"bib15-20250504","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1001\/jama.2020.10369","article-title":"Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2","volume":"324","year":"2020","journal-title":"JAMA"},{"key":"bib16-20250504","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1001\/jama.2021.2091","article-title":"Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19","volume":"325","year":"2021","journal-title":"JAMA"},{"key":"bib17-20250504","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jpeds.2020.06.044","article-title":"Characteristics, cardiac involvement, and outcomes of multisystem inflammatory syndrome of childhood associated with severe acute respiratory syndrome coronavirus 2 infection","volume":"224","year":"2020","journal-title":"J Pediatr"},{"key":"bib18-20250504","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1161\/CIRCULATIONAHA.120.049836","article-title":"Review of cardiac involvement in multisystem inflammatory syndrome in children","volume":"143","year":"2021","journal-title":"Circulation"},{"key":"bib19-20250504","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.15585\/mmwr.mm6932e2","article-title":"COVID-19-associated multisystem inflammatory syndrome in children\u2014United States, March\u2013July 2020","volume":"69","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bib20-20250504","first-page":"1794","article-title":"Multisystem inflammatory syndrome in children in the United States. Reply","volume":"383","year":"2020","journal-title":"N Engl J Med"},{"key":"bib21-20250504","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","year":"2007","journal-title":"Lancet"},{"key":"bib23-20250504","doi-asserted-by":"crossref","first-page":"3037","DOI":"10.1016\/j.vaccine.2021.01.054","article-title":"Multisystem inflammatory syndrome in children and adults (MIS-C\/A): case definition & guidelines for data collection, analysis, and presentation of immunization safety data","volume":"39","year":"2021","journal-title":"Vaccine"},{"key":"bib24-20250504","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJMoa2102605","article-title":"Multisystem inflammatory syndrome in children\u2014initial therapy and outcomes","volume":"385","year":"2021","journal-title":"N Engl J Med"},{"journal-title":"Clin Infect Dis","article-title":"The Infectious Diseases Society of America guidelines on the diagnosis of COVID-19: molecular diagnostic testing","year":"2021","key":"bib25-20250504"},{"key":"bib26-20250504","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1002\/emp2.12173","article-title":"Updates on pediatric sepsis","volume":"1","year":"2020","journal-title":"J Am Coll Emerg Physicians Open"},{"key":"bib27-20250504","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/PCC.0000000000002589","article-title":"Development and validation of a model to predict pediatric septic shock using data known 2 hours after hospital arrival","volume":"22","year":"2021","journal-title":"Pediatr Crit Care Med"},{"key":"bib28-20250504","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/S0140-6736(20)31094-1","article-title":"Hyperinflammatory shock in children during COVID-19 pandemic","volume":"395","year":"2020","journal-title":"Lancet"},{"issue":"16 suppl 2","key":"bib29-20250504","first-page":"S469","article-title":"Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"142","year":"2020","journal-title":"Circulation"},{"key":"bib30-20250504","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1097\/01.pec.0000227865.38815.ec","article-title":"Language and length of stay in the pediatric emergency department","volume":"22","year":"2006","journal-title":"Pediatr Emerg Care"},{"key":"bib31-20250504","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1186\/s12887-020-02400-6","article-title":"Type of facility influences lengths of stay of children presenting to high volume emergency departments","volume":"20","year":"2020","journal-title":"BMC Pediatr"},{"issue":"supplement","key":"bib32-20250504","first-page":"S111","article-title":"A comparison of length of stay between admitted and discharged pediatric patients in the emergency department (Abstract 307)","volume":"62","year":"2013","journal-title":"Ann Emerg Med"},{"key":"bib33-20250504","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","year":"2009","journal-title":"J Biomed Inform"},{"key":"bib34-20250504","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","year":"2019","journal-title":"J Biomed Inform"},{"key":"bib37-20250504","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1016\/j.jacc.2020.08.056","article-title":"Echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States","volume":"76","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"bib38-20250504","doi-asserted-by":"crossref","first-page":"e287","DOI":"10.1097\/INF.0000000000003204","article-title":"A Bayesian model to predict COVID-19 severity in children","volume":"40","year":"2021","journal-title":"Pediatr Infect Dis J"},{"key":"bib39-20250504","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/PCC.0000000000002198","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"21","year":"2020","journal-title":"Pediatr Crit Care Med"},{"key":"bib40-20250504","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1161\/CIRCULATIONAHA.120.050065","article-title":"Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe","volume":"143","year":"2021","journal-title":"Circulation"},{"key":"bib41-20250504","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/INF.0000000000003449","article-title":"Distinguishing multisystem inflammatory syndrome in children from COVID-19, Kawasaki disease and toxic shock syndrome","volume":"41","year":"2022","journal-title":"Pediatr Infect Dis J"},{"key":"bib42-20250504","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/jama.2021.0694","article-title":"Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children","volume":"325","year":"2021","journal-title":"JAMA"},{"key":"bib43-20250504","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1007\/s13312-022-2442-4","article-title":"Factors differentiating multisystem inflammatory syndrome in children (MIS-C) from severe\/critical COVID-19 infection in children","volume":"59","year":"2022","journal-title":"Indian Pediatr"},{"key":"bib44-20250504","doi-asserted-by":"crossref","first-page":"101112","DOI":"10.1016\/j.eclinm.2021.101112","article-title":"Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents","volume":"40","year":"2021","journal-title":"EClinicalMedicine"},{"key":"bib45-20250504","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1001\/jama.2020.10374","article-title":"Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City","volume":"324","year":"2020","journal-title":"JAMA"},{"key":"bib46-20250504","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.ajem.2020.09.076","article-title":"Emergency department screening for multisystem inflammatory syndrome (MIS-C) in children","volume":"46","year":"2021","journal-title":"Am J Emerg Med"},{"key":"bib47-20250504","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jpeds.2020.10.013","article-title":"Discriminating multisystem inflammatory syndrome in children requiring treatment from common febrile conditions in outpatient settings","volume":"229","year":"2021","journal-title":"J Pediatr"},{"key":"bib48-20250504","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1159\/000512007","article-title":"The impact of COVID-19 disease on platelets and coagulation","volume":"88","year":"2021","journal-title":"Pathobiology"},{"key":"bib49-20250504","doi-asserted-by":"crossref","first-page":"471","DOI":"10.3390\/cancers13030471","article-title":"Lymphopenia as a biological predictor of outcomes in COVID-19 patients: a nationwide cohort study","volume":"13","year":"2021","journal-title":"Cancers (Basel)"},{"key":"bib50-20250504","doi-asserted-by":"crossref","first-page":"e1165","DOI":"10.1093\/cid\/ciab1007","article-title":"Multisystem inflammatory syndrome in children-United States, February 2020\u2013July 2021","volume":"75","year":"2022","journal-title":"Clin Infect Dis"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T18:01:31Z","timestamp":1746381691000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002914"}},"subtitle":["A Multicenter Analysis From the New York City Tri-State Region"],"short-title":[],"issued":{"date-parts":[[2023,2,22]]},"references-count":44,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000002914","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"type":"electronic","value":"1535-1815"},{"type":"print","value":"0749-5161"}],"subject":[],"published":{"date-parts":[[2023,2,22]]}}}