{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T19:09:17Z","timestamp":1774120157477,"version":"3.50.1"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T00:00:00Z","timestamp":1656892800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T00:00:00Z","timestamp":1656892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["GM092804"],"award-info":[{"award-number":["GM092804"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["HD089939"],"award-info":[{"award-number":["HD089939"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["5K08HL143183"],"award-info":[{"award-number":["5K08HL143183"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Office of the Assistant Secretary for Preparedness and Response: Biomedical Advanced Research and Development Authority","award":["Under Contract No 75A0120C00189"],"award-info":[{"award-number":["Under Contract No 75A0120C00189"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background and Objectives<\/jats:title>\n                <jats:p>Multisystem Inflammatory Syndrome in Children (MIS-C) is an emerging complication of COVID-19 which lacks a definitive diagnostic test and evidence-based guidelines for workup. We sought to assess practitioners' preferences when initiating a workup for pediatric patients presenting with symptoms concerning for MIS-C.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In a cross-sectional vignette-based survey, providers were presented with clinical vignettes of a patient presenting with 24\u00a0h of fever from a community with high rates of COVID-19. Respondents were asked about their general practices in pursuing a workup for potential MIS-C including testing obtained, criteria for diagnosis, and timing to confirm or rule out the diagnosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Most of the 174 respondents were physicians from the United States at academic medical centers. The majority of providers would not initiate MIS-C workup for fever and non-specific symptoms unless the fever lasted more than 72\u00a0h. Skin rash, abdominal pain, and shortness of breath were symptoms that raised greatest concern for MIS-C. Most providers would obtain COVID-19 PCR or antigen testing, plus blood work, in the initial workup. The list of laboratory studies providers would obtain is extensive. Providers primarily rely on cardiac involvement to confirm a MIS-C diagnosis, and establishing a diagnosis takes 24\u201348\u00a0h.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Significant heterogeneity exists amongst providers as to when to initiate the MIS-C workup, the order and content of the workup, and how to definitively diagnose MIS-C. A diagnostic test with high sensitivity and specificity for MIS-C and refined evidence-based guidelines are needed to expedite diagnosis and treatment.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12887-022-03446-4","type":"journal-article","created":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T12:11:18Z","timestamp":1656936678000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Heterogeneity in the evaluation of suspected MIS-C: a cross-sectional vignette-based survey"],"prefix":"10.1186","volume":"22","author":[{"given":"Claudia A.","family":"Rosu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna M.","family":"Martens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Sumner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva J.","family":"Farkas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puneeta","family":"Arya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexy Boudreau","family":"Arauz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vandana L.","family":"Madhavan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector","family":"Chavez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shawn D.","family":"Larson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwakemi","family":"Badaki-Makun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Irimia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lael M.","family":"Yonker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,7,4]]},"reference":[{"key":"3446_CR1","unstructured":"Multisystem inflammatory syndrome (MIS). Centers for disease control and prevention. Published https:\/\/www.cdc.gov\/mis\/mis-c\/hcp\/index.html. 2020. Accessed 17 Oct\u00a0\u00a02021."},{"key":"3446_CR2","doi-asserted-by":"publisher","first-page":"117863372110266","DOI":"10.1177\/11786337211026642","volume":"14","author":"A Farooq","year":"2021","unstructured":"Farooq A, Alam F, Saeed A, et al. Multisystem Inflammatory Syndrome in Children and adolescents (MIS-C) under the setting of COVID-19: a review of clinical presentation, workup and management. Infect Dis (Auckl). 2021;14:11786337211026642 Published 2021 Jun 20.","journal-title":"Infect Dis (Auckl)"},{"issue":"4","key":"3446_CR3","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1056\/NEJMoa2021680","volume":"383","author":"LR Feldstein","year":"2020","unstructured":"Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334\u201346. https:\/\/doi.org\/10.1056\/NEJMoa2021680.","journal-title":"N Engl J Med"},{"issue":"14","key":"3446_CR4","doi-asserted-by":"publisher","first-page":"149633","DOI":"10.1172\/JCI149633","volume":"131","author":"LM Yonker","year":"2021","unstructured":"Yonker LM, Gilboa T, Ogata AF, et al. Multisystem inflammatory syndrome in children is driven by zonulin-dependent loss of gut mucosal barrier. J Clin Invest. 2021;131(14):149633. https:\/\/doi.org\/10.1172\/JCI149633","journal-title":"J Clin Invest"},{"issue":"20","key":"3446_CR5","doi-asserted-by":"publisher","first-page":"e151520","DOI":"10.1172\/JCI151520","volume":"131","author":"RA Porritt","year":"2021","unstructured":"Porritt RA, Binek A, Paschold L, et al. The autoimmune signature of hyperinflammatory multisystem inflammatory syndrome in children. J Clin Invest. 2021;131(20):e151520. https:\/\/doi.org\/10.1172\/JCI151520.","journal-title":"J Clin Invest"},{"issue":"10","key":"3446_CR6","doi-asserted-by":"publisher","first-page":"146614","DOI":"10.1172\/JCI146614","volume":"131","author":"RA Porritt","year":"2021","unstructured":"Porritt RA, Paschold L, Rivas MN, et al. HLA class I-associated expansion of TRBV11-2 T cells in multisystem inflammatory syndrome in children. J Clin Invest. 2021;131(10):146614. https:\/\/doi.org\/10.1172\/JCI146614.","journal-title":"J Clin Invest"},{"issue":"11","key":"3446_CR7","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1002\/art.41454","volume":"72","author":"LA Henderson","year":"2020","unstructured":"Henderson LA, Canna SW, Friedman KG, et al. American college of rheumatology clinical guidance for multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1. Arthritis Rheumatol. 2020;72(11):1791\u2013805. https:\/\/doi.org\/10.1002\/art.41454.","journal-title":"Arthritis Rheumatol"},{"key":"3446_CR8","unstructured":"Multisystem Inflammatory Syndrome in Children (MIS-C) interim guidance. Am Acad Pediatr. https:\/\/www.aap.org\/en\/pages\/2019-novel-coronavirus-covid-19-infections\/clinical-guidance\/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance\/. Accessed\u00a017 Oct\u00a0\u00a02021."},{"key":"3446_CR9","unstructured":"Children and COVID-19: state-level data report. Am Acad Pediatr. http:\/\/www.aap.org\/en\/pages\/2019-novel-coronavirus-covid-19-infections\/children-and-covid-19-state-level-data-report\/. Accessed\u00a017 Oct\u00a02021."},{"key":"3446_CR10","doi-asserted-by":"publisher","unstructured":"Wu EY, Campbell MJ. Cardiac manifestations of multisystem Inflammatory Syndrome in Children (MIS-C) following COVID-19. Curr Cardiol Rep. 2021;23(11):168. Published 2021 Oct 1. https:\/\/doi.org\/10.1007\/s11886-021-01602-","DOI":"10.1007\/s11886-021-01602"},{"issue":"5","key":"3446_CR11","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1007\/s00431-022-04390-2","volume":"181","author":"D Yilmaz Ciftdogan","year":"2022","unstructured":"Yilmaz Ciftdogan D, Ekemen Keles Y, Cetin BS, et al. COVID-19 associated multisystemic inflammatory syndrome in 614 children with and without overlap with Kawasaki disease-Turk MIS-C study group. Eur J Pediatr. 2022;181(5):2031\u201343. https:\/\/doi.org\/10.1007\/s00431-022-04390-2.","journal-title":"Eur J Pediatr"}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-022-03446-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-022-03446-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-022-03446-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T12:12:40Z","timestamp":1656936760000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpediatr.biomedcentral.com\/articles\/10.1186\/s12887-022-03446-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,4]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["3446"],"URL":"https:\/\/doi.org\/10.1186\/s12887-022-03446-4","relation":{},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,4]]},"assertion":[{"value":"2 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Providers were invited via email to anonymously participate in an on-line survey. Participation in the survey was voluntary. Participants were provided with an IRB-approved statement declaring that informed consent was implied by opening the survey link. The Mass General Brigham Institutional Review Board approved this study (MGB IRB #2020P003972). All methods were performed in accordance with the relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no conflicts of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"392"}}