316 - Twelve Months of MIS-C: Does Increasing Experience Improve Resource Utilization?

Poster Number: 316
Publication Number: 316.213

Shea Osburn, University of California, San Francisco, School of Medicine, Fresno, CA, United States; Nicole E. Webb, Valley Children’s Healthcare, Madera, CA, United States; Victoria Acharya, Valley Children's Healthcare, Madera, CA, United States; Rhonda Keosheyan, Valley Children's Healthcare, Madera, CA, United States; Chloe Kupelian, Valley Children's Healthcare, Fresno, CA, United States

Background: Available guidelines for the diagnosis and management of Multisystem Inflammatory Syndrome in Children (MIS-C ) include an array of labs that have a varying impact on management decisions. In our clinical experience these patients have many blood draws with the goal of trending these lab values. However, only a few of these values appear to guide the management. In the available guidelines, there are no specific recommendations for frequency of lab draws or need to repeat labs that are normal on presentation.

Objective: We sought to determine if resource utilization, specifically laboratory utilization, improved with time and better understanding of the disease process, in addition to seeking to determine which of the recommended labs were most consistently abnormal.

Design/Methods: Retrospective case series of all patients < 22 years hospitalized with a discharge diagnosis of MIS-C between 5/1/20 and 4/30/21, the first year of MIS-C at our center. Demographic, clinical and outcome data was collected and analyzed. We performed an analysis comparing resource utilization and outcomes in the first versus second six months in the time period.
 

Results: We found that 48% of our population had a greater than 2 g/dl drop in their hemoglobin during their hospitalization. 73% had a 1g/dl or greater drop. Of the recommended labs, CRP (100%), D-dimer (98%), Ferritin (91%),  ESR (87%) Procalcitonin (85%), Fibrinogen (85%) and BNP (85%) were most frequently abnormal. Triglycerides (17%), PT/PTT (50%) and LDH (59%) were the least frequently abnormal. Between the two defined time periods, there were no significant differences in demographics, laboratory abnormalities, diagnostic findings, length of stay, or need for ICU admission. Overall, there was no statistically significant improvement in the number of lab draws obtained between the two time periods aside from lab draws for triglycerides (p=.049). Conclusion(s): Laboratory resource utilization for MIS-C did not improve over the first year of MIS-C cases at our organization. Patients with MIS-C frequently experienced significant drops in hemoglobin. Given that our global experience with MIS-C has shown that nearly all of these patients recover completely and relatively quickly, there is likely opportunity to refine the available guidelines for the management of MIS-C to both define the interval at which labs need to be trended as well as to exclude those that have low impact on diagnostic and management decisions for this disease process. Additionally, dedicated quality improvement efforts to reduce over-testing in this patient population are indicated.
 
Lab findings in MIS-C Population
Number of Lab Draws by Time Period