A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

Rachel Harwood, Benjamin Allin, Christine E Jones, Elizabeth Whittaker, Padmanabhan Ramnarayan, Athimalaipet V Ramanan, Musa Kaleem, Robert Tulloh, Mark J Peters, Sarah Almond, Peter J Davis, Michael Levin, Andrew Tometzki, Saul N Faust, Marian Knight, Simon Kenny, PIMS-TS National Consensus Management Study Group, Rachel Agbeko, Octavio Aragon, Jim Baird, Alasdair Bamford, Michael Bereford, Tara Bharucha, Paul Brogan, Karina Butler, Enitan Carroll, Katrina Cathie, Ashish Chikermane, Sharon Christie, Matthew Clark, Antigoni Deri, Conor Doherty, Simon Drysdale, Phouc Duong, Saravanan Durairaj, Marieke Emonts, Jennifer Evans, James Fraser, Scott Hackett, Rosie Hague, Paul Heath, Jethro Herberg, Marina Ilina, Nicola Jay, Dominic Kelly, Caroline Kerrison, Jeannette Kraft, Alice Leahy, Mike Linney, Hermione Lyall, Liza McCann, Paddy McMaster, Owen Miller, Sean O'Riordan, Stephen Owens, Clare Pain, Sanjay Patel, Nazima Pathan, James Pauling, David Porter, Andrew Prendergast, Kumar Ravi, Andrew Riorden, Marion Roderick, Barnaby R Scholefield, Malcolm G Semple, Ethan Sen, Fiona Shackley, Ian Sinha, Shane Tibby, Stefania Verganano, Steven B Welch, Nicholas Wilkinson, Mark Wood, Iain Yardley, Rachel Harwood, Benjamin Allin, Christine E Jones, Elizabeth Whittaker, Padmanabhan Ramnarayan, Athimalaipet V Ramanan, Musa Kaleem, Robert Tulloh, Mark J Peters, Sarah Almond, Peter J Davis, Michael Levin, Andrew Tometzki, Saul N Faust, Marian Knight, Simon Kenny, PIMS-TS National Consensus Management Study Group, Rachel Agbeko, Octavio Aragon, Jim Baird, Alasdair Bamford, Michael Bereford, Tara Bharucha, Paul Brogan, Karina Butler, Enitan Carroll, Katrina Cathie, Ashish Chikermane, Sharon Christie, Matthew Clark, Antigoni Deri, Conor Doherty, Simon Drysdale, Phouc Duong, Saravanan Durairaj, Marieke Emonts, Jennifer Evans, James Fraser, Scott Hackett, Rosie Hague, Paul Heath, Jethro Herberg, Marina Ilina, Nicola Jay, Dominic Kelly, Caroline Kerrison, Jeannette Kraft, Alice Leahy, Mike Linney, Hermione Lyall, Liza McCann, Paddy McMaster, Owen Miller, Sean O'Riordan, Stephen Owens, Clare Pain, Sanjay Patel, Nazima Pathan, James Pauling, David Porter, Andrew Prendergast, Kumar Ravi, Andrew Riorden, Marion Roderick, Barnaby R Scholefield, Malcolm G Semple, Ethan Sen, Fiona Shackley, Ian Sinha, Shane Tibby, Stefania Verganano, Steven B Welch, Nicholas Wilkinson, Mark Wood, Iain Yardley

Abstract

Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a novel condition that was first reported in April, 2020. We aimed to develop a national consensus management pathway for the UK to provide guidance for clinicians caring for children with PIMS-TS. A three-phase online Delphi process and virtual consensus meeting sought consensus over the investigation, management, and research priorities from multidisciplinary clinicians caring for children with PIMS-TS. We used 140 consensus statements to derive a consensus management pathway that describes the initial investigation of children with suspected PIMS-TS, including blood markers to help determine the severity of disease, an echocardiogram, and a viral and septic screen to exclude other infectious causes of illness. The importance of a multidisciplinary team in decision making for children with PIMS-TS is highlighted throughout the guidance, along with the recommended treatment options, including supportive care, intravenous immunoglobulin, methylprednisolone, and biological therapies. These include IL-1 antagonists (eg, anakinra), IL-6 receptor blockers (eg, tocilizumab), and anti-TNF agents (eg, infliximab) for children with Kawasaki disease-like phenotype and non-specific presentations. Use of a rapid online Delphi process has made it possible to generate a national consensus pathway in a timely and cost-efficient manner in the middle of a global pandemic. The consensus statements represent the views of UK clinicians and are applicable to children in the UK suspected of having PIMS-TS. Future evidence will inform updates to this guidance, which in the interim provides a solid framework to support clinicians caring for children with PIMS-TS. This process has directly informed new PIMS-TS specific treatment groups as part of the adaptive UK RECOVERY trial protocol, which is the first formal randomised controlled trial of therapies for PIMS-TS globally.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

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Figure
Flow of statements through consensus process *Near consensus meaning ≥70% agreement in two of three panels.

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