Clinical Update: Paediatric shock

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An alert has been passed to all Urgent and Emergency Care (UEC) and Integrated Urgent Care (IUC) sectors regarding an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care (please see the alert email below).

The assessment of any sick child requires careful consideration of elements such as compensation, ability to communicate and use of carers and parents to guide what is normal/abnormal.It is worth reminding ourselves of the available guidance provided by NICE regards spotting the sick child and red flags used to assist in our decision making.
If you have any doubt over the presentation of a sick child or want to share the decision making, utilise the Clinical Advice Line (CAL) or primary care colleagues to aid in the safety netting.


Alert message:
Over the last 3 weeks there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK.
The cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki Disease with blood parameters consistent with severe COVID-19 in children.
Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation.
This has been observed in children with confirmed PCR positive SARS-CoV-2 infection as well as children who are PCR negative.
Serological evidence of possible preceding SARS-CoV-2 infection has also been observed.
There is a growing concern that a SARS-CoV-2 related inflammatory syndrome emerging in children in the UK or that there may be another, as yet unidentified, infectious pathogen associated with these cases.

This clinical update can be downloaded as a PDF file below.

Published 28th April 2020



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