Epidemiology and role of SARS-CoV-2 Linkage in Paediatric Inflammatory Multisystem Syndrome (PIMS): A Canadian Paediatric Surveillance Program National Prospective Study

  1. Tala El Tal
  2. Marie-Paule Morin
  3. Shaun K. Morris
  4. Daniel S. Farrar
  5. Roberta A Berard
  6. Fatima Kakkar
  7. Charlotte Moore Hepburn
  8. Krista Baerg
  9. Camille Beaufils
  10. Terri-Lyn Bennett
  11. Susanne M Benseler
  12. Guillaume Beaudoin-Bussières
  13. Kevin Chan
  14. Claude Cyr
  15. Nagib Dahdah
  16. Elizabeth J. Donner
  17. Olivier Drouin
  18. Rojiemiahd Edjoc
  19. Maryem Eljaouhari
  20. Joanne E. Embree
  21. Catherine Farrell
  22. Andrés Finzi
  23. Sarah Forgie
  24. Ryan Giroux
  25. Kristopher T. Kang
  26. Melanie King
  27. Melanie Laffin Thibodeau
  28. Bianca Lang
  29. Ronald M. Laxer
  30. Thuy Mai Luu
  31. Brian W. McCrindle
  32. Julia Orkin
  33. Jesse Papenburg
  34. Catherine M. Pound
  35. Victoria E. Price
  36. Jean-Philippe Proulx-Gauthier
  37. Rupeena Purewal
  38. Manish Sadarangani
  39. Marina l. Salvadori
  40. Roseline Thibeault
  41. Karina A. Top
  42. Isabelle Viel-Thériault
  43. Elie Haddad
  44. Rosie Scuccimarri
  45. Rae S. M. Yeung

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Abstract

Background

Paediatric inflammatory multisystem syndrome (PIMS) is a rare but serious condition temporally associated with SARS-CoV-2 infection. Using the Canadian Paediatric Surveillance Program (CPSP), a national surveillance system, we aimed to 1) study the impact of SARS-CoV-2 linkage on clinical and laboratory characteristics, and outcomes in hospitalized children with PIMS across Canada 2) identify risk factors for ICU admission, and 3) establish the minimum national incidence of hospitalizations due to PIMS and compare it to acute COVID-19.

Methods

Weekly online case reporting was distributed to the CPSP network of more than 2800 pediatricians, from March 2020 to May 2021. Comparisons were made between cases with respect to SARS-CoV-2 linkage. Multivariable modified Poisson regression was used to identify risk factors for ICU admission and Minimum incidence proportions were calculated.

Findings

In total, 406 PIMS cases were analyzed, of whom 202 (49· 8%) had a positive SARS-CoV-2 linkage, 106 (26· 1%) had a negative linkage, and 98 (24· 1%) had an unknown linkage. The median age was 5· 4 years (IQR 2· 5–9· 8), 60% were male, and 83% had no identified comorbidities. Compared to cases with a negative SARS-CoV-2 linkage, children with a positive SARS-CoV-2 linkage were older (8· 1 years [IQR 4· 2–11· 9] vs. 4· 1 years [IQR 1· 7–7· 7]; p<0· 001), had more cardiac involvement (58· 8% vs. 37· 4%; p<0· 001), gastrointestinal symptoms (88· 6% vs. 63· 2%; p<0· 001), and shock (60· 9% vs. 16· 0%; p<0· 001). At–risk groups for ICU admission include children ≥ 6 years and those with a positive SARS-CoV-2 linkage. No deaths were reported. The minimum incidence of PIMS hospitalizations during the study period was 5· 6 hospitalizations per 100,000 population <18 years.

Interpretation

While PIMS is rare, almost 1 in 3 hospitalized children required ICU admission and respiratory/hemodynamic support, particularly those ≥ 6 years and with a positive SARS-CoV-2 linkage.

Funding

Financial support for the CPSP was received from the Public Health Agency of Canada.

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  1. ScreenIT

    SciScore for 10.1101/2022.05.27.22275613: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has a few limitations. The voluntary nature of CPSP reporting means that not all cases may have been reported. Second, the online PIMS case report form was developed soon after the first identification of the clinical entity, therefore data on other important clinical or laboratory markers such as NT-proBNP and lymphopenia were not included in the study. In addition, several indicators ascertained by physician report, including population group of the child and cardiac findings such as myocarditis and shock were not based on pre-defined diagnostic criteria.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.05.27.22275613v1 on medRxiv