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A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS)

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS)
A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS)
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
2352-4650
133-141
Harwood, Rachel
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Allin, Benjamin
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Jones, Christine E.
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Whittaker, Elizabeth
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Ramnarayan, Padmanabhan
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Ramanan, Athimalaipet V.
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Kaleem, Musa
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Tulloh, Robert
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Peters, Mark J.
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Almond, Sarah
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Davis, Peter J.
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Levin, Michael
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Tometzki, Andrew
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Faust, Saul
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Knight, Marian
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Kenny, Simon
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PIMS-TS National Consensus Management Study Group
Harwood, Rachel
7c4ee431-89f4-4a9f-a050-24fd4e361295
Allin, Benjamin
38689f5b-299a-45b0-9c61-7619ca524602
Jones, Christine E.
48229079-8b58-4dcb-8374-d9481fe7b426
Whittaker, Elizabeth
fed4bf4b-de8f-4656-9fa6-c8900d60fb88
Ramnarayan, Padmanabhan
e37f4786-cce0-4505-a714-381b46e54744
Ramanan, Athimalaipet V.
bfada78a-5a58-4bde-99cd-b753750281c2
Kaleem, Musa
013fd769-558f-4a52-9355-5bc234453365
Tulloh, Robert
b83b00f3-ccae-4c98-a3b2-2cf9d5d29d82
Peters, Mark J.
a1db2568-cc2a-4672-8765-6340ee2d4972
Almond, Sarah
732d9e07-d041-42b0-a7f0-6ba5c391450c
Davis, Peter J.
20400357-d5c9-4b02-89f0-8ecf5c9ebb36
Levin, Michael
2be78359-2a08-4885-a83c-4f7a6d1de986
Tometzki, Andrew
6f159003-77ba-411c-b5d6-4e677e69e646
Faust, Saul
f97df780-9f9b-418e-b349-7adf63e150c1
Knight, Marian
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Kenny, Simon
3dfd9875-1b46-4102-b4c5-1d631855582c

Harwood, Rachel, Allin, Benjamin, Jones, Christine E., Whittaker, Elizabeth, Ramnarayan, Padmanabhan, Ramanan, Athimalaipet V., Kaleem, Musa, Tulloh, Robert, Peters, Mark J., Almond, Sarah, Davis, Peter J., Levin, Michael, Tometzki, Andrew, Faust, Saul, Knight, Marian and Kenny, Simon , PIMS-TS National Consensus Management Study Group (2021) A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS). The Lancet Child & Adolescent Health, 5 (2), 133-141. (doi:10.1016/S2352-4642(20)30304-7).

Record type: Article

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

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Accepted/In Press date: 12 August 2020
e-pub ahead of print date: 18 September 2020
Published date: 1 February 2021

Identifiers

Local EPrints ID: 443820
URI: http://eprints.soton.ac.uk/id/eprint/443820
ISSN: 2352-4650
PURE UUID: 45ae4839-9da1-4fb0-ad86-dc4839e38e47
ORCID for Christine E. Jones: ORCID iD orcid.org/0000-0003-1523-2368
ORCID for Saul Faust: ORCID iD orcid.org/0000-0003-3410-7642

Catalogue record

Date deposited: 14 Sep 2020 16:31
Last modified: 26 Nov 2021 06:17

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Contributors

Author: Rachel Harwood
Author: Benjamin Allin
Author: Elizabeth Whittaker
Author: Padmanabhan Ramnarayan
Author: Athimalaipet V. Ramanan
Author: Musa Kaleem
Author: Robert Tulloh
Author: Mark J. Peters
Author: Sarah Almond
Author: Peter J. Davis
Author: Michael Levin
Author: Andrew Tometzki
Author: Saul Faust ORCID iD
Author: Marian Knight
Author: Simon Kenny
Corporate Author: PIMS-TS National Consensus Management Study Group

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