• Kellie Snooks, Matthew C Scanlon, Kenneth E Remy, Steven L Shein, Margaret J Klein, Janine Zee-Cheng, Colin M Rogerson, Alexandre T Rotta, Anna Lin, Casey K McCluskey, and Christopher L Carroll.
• Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
• Pediatr Crit Care Me. 2022 Nov 1; 23 (11): e530e535e530-e535.

ObjectivesTo characterize the prevalence of pediatric critical illness from multisystem inflammatory syndrome in children (MIS-C) and to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain on outcomes.DesignRetrospective cohort study.SettingDatabase evaluation using the Virtual Pediatric Systems Database.PatientsAll children with MIS-C admitted to the PICU in 115 contributing hospitals between January 1, 2020, and June 30, 2021.Measurements And Main ResultsOf the 145,580 children admitted to the PICU during the study period, 1,338 children (0.9%) were admitted with MIS-C with the largest numbers of children admitted in quarter 1 (Q1) of 2021 ( n = 626). The original SARS-CoV-2 viral strain and the D614G Strain were the predominant strains through 2020, with Alpha B.1.1.7 predominating in Q1 and quarter 2 (Q2) of 2021. Overall, the median PICU length of stay (LOS) was 2.7 days (25-75% interquartile range [IQR], 1.6-4.7 d) with a median hospital LOS of 6.6 days (25-75% IQR, 4.7-9.3 d); 15.2% received mechanical ventilation with a median duration of mechanical ventilation of 3.1 days (25-75% IQR, 1.9-5.8 d), and there were 11 hospital deaths. During the study period, there was a significant decrease in the median PICU and hospital LOS and a decrease in the frequency of mechanical ventilation, with the most significant decrease occurring between quarter 3 and quarter 4 (Q4) of 2020. Children admitted to a PICU from the general care floor or from another ICU/step-down unit had longer PICU LOS than those admitted directly from an emergency department.ConclusionsOverall mortality from MIS-C was low, but the disease burden was high. There was a peak in MIS-C cases during Q1 of 2021, following a shift in viral strains in Q1 of 2021. However, an improvement in MIS-C outcomes starting in Q4 of 2020 suggests that viral strain was not the driving factor for outcomes in this population.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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