Freitas Joana, Sanpera Julia, Dessouki Tareq, Rainsley Victoria, Nyirenda Maggie, Canet Tarrés Anna, Thomas Jessica
General Paediatrics, Queen Elizabeth Hospital, London, UK
General Paediatrics, Queen Elizabeth Hospital, London, UK.
Arch Dis Child Educ Pract Ed. 2022 Dec;107(6):408-414. doi: 10.1136/archdischild-2021-321921. Epub 2021 Oct 25.
The COVID-19 pandemic has caused significant disease across the globe but children seem to be much less affected than adults. Coincidentally with the first wave of the pandemic, a cluster of children with fever, hyperinflammation and shock were identified, and this was first described as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) by the Royal College of Paediatrics and Child Health. Patients with this novel condition were transferred to tertiary centres for management, increasing the pressure in these hospitals that were already extremely busy. There are multiple challenges related to the identification of patients presenting with PIMS-TS given that they mimic multiple other well-known paediatric conditions, like Kawasaki disease and toxic shock syndrome. Investigations and admission criteria to a district general hospital (DGH) need to be well established, and clear guidance should be available for easy decision making in a busy paediatric emergency department. Furthermore, these children can deteriorate suddenly and rapidly; close monitoring is vital, and any deterioration must be taken seriously and addressed immediately. All children who present severely ill, with shock and multiorgan failure, should be retrieved to a paediatric intensive care unit. As our knowledge of the condition has developed, more patients are now managed in a DGH, with virtual multidisciplinary team involvement. This paper outlines a structured approach to management of children presenting with suspected PIMS-TS in a DGH.
新冠疫情在全球范围内引发了严重疾病，但儿童受影响的程度似乎远低于成人。在疫情第一波期间，一群出现发热、炎症反应过度和休克的儿童被发现，英国皇家儿科学会和儿童健康学会首次将其描述为与新冠病毒（SARS-CoV-2）暂时相关的儿童炎症性多系统综合征（PIMS-TS）。患有这种新病症的患者被转至三级医疗中心进行治疗，这增加了本就极为繁忙的医院的压力。鉴于PIMS-TS患者的症状与其他多种知名儿科病症（如川崎病和中毒性休克综合征）相似，因此在识别此类患者时存在诸多挑战。需要明确地区综合医院（DGH）的检查和收治标准，并且应提供清晰的指导，以便在繁忙的儿科急诊科做出轻松的决策。此外，这些儿童可能会突然迅速恶化；密切监测至关重要，任何恶化情况都必须予以重视并立即处理。所有病情严重、出现休克和多器官功能衰竭的儿童都应被转至儿科重症监护病房。随着我们对该病症认识的不断发展，现在有更多患者在地区综合医院接受治疗，并通过虚拟多学科团队参与管理。本文概述了在地区综合医院管理疑似PIMS-TS儿童的结构化方法。
