Thread by @apsmunro

Cool study in @CDCMMWR about #MISC #PIMSTS in the US

cdc.gov/mmwr/volumes/6…

Taking 570 reported cases (med age 8y, 40% hispanic/latino, 33% black) they performed statistical analysis to break cases down into 3 categories

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Using a method called latent class analysis (a supervised technique maximising differences between classes and minimising differences within classes) they created 3 gruops - the breakdown is interesting so lets take a look!

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Group 1: "Classic" MISC/PIMSTS which is features of muti-organ involvement and shock with only 1/3 patients testing positive on rtPCR

Group 2: High respiratory involvement and vast majority testing positive for SARS-CoV-2 rt PCR

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Group 3: Patients resembling Kawasaki disease with usual features of rash, conjunctivitis, mucosal changes etc

These groups are in contrast to previous grouping in the paper by @lizWWyld et al in @JAMA_current which were as follows:

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1. Children with high inflammatory markers/fever but mild illness and few signs of Kawasaki disease

2. Children with multiorgan involvement and shock (similar to group 1 in CDC data)

3. Children who met Kawasaki disease criteria

jamanetwork.com/journals/jama/…

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What's interesting is the CDC data misses children with slightly milder disease, but includes children with what seems more like severe, acute COVID-19 than what I think of as MISC/PIMSTS

Looking at the case definitions, I'm not sure of the reason for this

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I'd be interested to hear from #PedsICU people or other paeds ID on their experience and whether the acute COVID-19 ARDS children cross over with the MISC/PIMSTS children?

May have implications for therapeutics?

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@SapnaKmd @ChrisCarrollMD @MJGriksaitis @DrKanaris