Table 2:

Comparison of case definitions for pediatric inflammatory multisystem syndrome5

FeatureSource of definition
RCPCH2CDC3WHO4CPSP5
Name of syndromePediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS)Multisystem inflammatory syndrome in children (MIS-C)Multisystem inflammatory syndrome in children (MIS-C)Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS)
FeverPersistent at > 38.5 °C> 38.0 °C OR subjective ≥ 24 h≥ 3 d> 38.0 °C for ≥ 3 d
AgeNot specified “child”< 21 yr0–19 yr< 18 yr
MultisystemSingle organ or multiorgan dysfunction AND additional features*≥ 2 organ systems≥ 2 featuresNot specified but implied§
Laboratory featuresNeutrophilia, lymphopenia and elevated CRPOne or more of the following: elevated CRP, ESR, fibrinogen, procalcitonin, d-dimer, ferritin, LDH or IL-6; neutrophilia, lymphopenia, low albuminElevated ESR, CRP or procalcitoninElevated CRP, ESR or ferritin
Excludes other causesNoNoYesNo
SARS-CoV-2 PCR, antibodies or exposure necessaryNoYesYesNo
  • Note: CDC = Centers for Disease Control and Prevention, COVID-19 = coronavirus disease 2019, CPSP = Canadian Paediatric Surveillance Program, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, IL-6 = interleukin 6, LDH = lactate dehydrogenase, NT-proBNP = N-terminal-pro-brain natriuretic peptide, RCPCH = Royal College of Paediatrics and Child Health, SARS-CoV-2-PCR = severe acute respiratory syndrome coronavirus 2 polymerase chain reaction, WHO = World Health Organization. Source: Adapted from Berard RA, Scuccimarri R, Haddad EM, et al. Paediatric inflammatory multisystem syndrome temporally associated with COVID-19: www.cps.ca/en/documents/position/pims.5

  • * Shock, cardiac, respiratory, renal, gastrointestinal or neurologic disorder. This may include children with full or partial criteria for Kawasaki disease.

  • Cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurologic systems.

  • Admission to hospital and 2 of the following: rash, bilateral nonpurulent conjunctivitis, mucocutaneous inflammation signs (oral, hands or feet); hypotension or shock; cardiac involvement: features of myocardial dysfunction, pericarditis, valvulitis or coronary abnormalities (including echocardiography findings or elevated troponin/NT-proBNP); evidence of coagulopathy (by prothrombin time, partial thromboplastin time, elevated d-dimers); acute gastrointestinal problems (diarrhea, vomiting or abdominal pain).

  • § Admission to hospital and features of Kawasaki disease (complete or incomplete) or toxic shock syndrome (typical or atypical).