Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania.
Arthritis Rheumatol. 2020 Nov;72(11):1791-1805. doi: 10.1002/art.41454. Epub 2020 Oct 3.
To provide guidance on the management of multisystem inflammatory syndrome in children (MIS-C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and to provide recommendations for children with hyperinflammation during coronavirus disease 2019 (COVID-19), the acute, infectious phase of SARS-CoV-2 infection.
A multidisciplinary task force was convened by the American College of Rheumatology (ACR) to provide guidance on the management of MIS-C associated with SARS-CoV-2 and hyperinflammation in COVID-19. The task force was composed of 9 pediatric rheumatologists, 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS-C and hyperinflammation in COVID-19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved 2 rounds of anonymous voting and 2 webinars. A 9-point scale was used to determine the appropriateness of each statement (median scores of 1-3 for inappropriate, 4-6 for uncertain, and 7-9 for appropriate), and consensus was rated as low, moderate, or high based on dispersion of the votes along the numeric scale. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, as prespecified prior to voting.
The ACR task force approved a total of 128 guidance statements addressing the management of MIS-C and hyperinflammation in pediatric COVID-19. These statements were refined into 40 final clinical guidance statements, accompanied by a flow diagram depicting the diagnostic pathway for MIS-C.
Our understanding of SARS-CoV-2-related syndromes in the pediatric population continues to evolve. The guidance provided in this "living document" reflects currently available evidence, coupled with expert opinion, and will be revised as further evidence becomes available.
为儿童多系统炎症综合征 (MIS-C) 的管理提供指导，MIS-C 是一种以发热、炎症和多器官功能障碍为特征的疾病，在严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染过程中晚期出现，并为 COVID-19 期间伴有高炎症的儿童提供建议，即 SARS-CoV-2 感染的急性传染性阶段。
美国风湿病学会 (ACR) 召集了一个多学科工作组，为与 SARS-CoV-2 相关的 MIS-C 以及 COVID-19 中的高炎症管理提供指导。工作组由 9 名儿科风湿病学家、2 名成人风湿病学家、2 名儿科心脏病专家、2 名儿科传染病专家和 1 名儿科重症监护医生组成。根据证据报告制定了初步声明，以解决与 MIS-C 和 COVID-19 中的高炎症相关的临床问题。通过两轮匿名投票和两次网络研讨会建立共识。使用 9 分制来确定每个声明的适当性（中位数为 1-3 表示不适当，4-6 表示不确定，7-9 表示适当），根据投票在数字尺度上的分布，共识分为低、中或高。投票前指定，批准的指导声明是那些被归类为适当且具有中等或高度共识的声明。
ACR 工作组共批准了 128 条针对儿科 COVID-19 中 MIS-C 和高炎症管理的指导声明。这些声明被细化为 40 条最终临床指导声明，并附有描绘 MIS-C 诊断途径的流程图。
我们对儿童人群中与 SARS-CoV-2 相关综合征的理解仍在不断发展。本“活文件”中提供的指导反映了当前可用的证据，加上专家意见，并且随着更多证据的出现，将进行修订。
