- Age <21 years
- Fever
- Documented fever ≥38.0°C (≥100.4°F)
or - Report of subjective fever
- Severe illness requiring hospitalization or resulting in death
- Laboratory evidence of systemic inflammation (CRP ≥3 mg/dL)
- Multisystem involvement – New-onset manifestations in 2 or more categories:
- Shock
- Cardiovascular (elevated troponin or LVEF <55% or CA dilation, aneurysm, or ectasia on echocardiogram)
- Hematologic (platelet count <150,000 cells/microL or absolute lymphocyte count <1000 cells/microL)
- Gastrointestinal (abdominal pain, vomiting, or diarrhea)
- Dermatologic (erythema or edema of hands or feet, oral mucositis, drying or fissuring of the lips, strawberry tongue, conjunctivitis, or other rash)
-
- Confirmation of SARS-CoV-2 infection with any of the following:
- Positive RNA (eg, RT-PCR) during hospitalization or within 60 days prior or postmortem
- Positive antibodies (serology) associated with current illness
- Positive antigen test during hospitalization or within 60 days prior or postmortem
or - Evidence of exposure – Close contact with a confirmed or probable COVID-19 case within 60 days prior to hospitalization
- No alternative plausible diagnoses
| - Age 0 to 19 years
- Fever for >3 days
- Clinical signs of multisystem involvement (at least 2 of the following):
- Rash, bilateral nonpurulent conjunctivitis, or mucocutaneous inflammation signs (oral, hands, or feet)
- Hypotension or shock
- Cardiac dysfunction, pericarditis, valvulitis, or coronary abnormalities (including echocardiographic findings or elevated troponin/BNP)
- Evidence of coagulopathy (prolonged PT or PTT; elevated D-dimer)
- Acute gastrointestinal symptoms (diarrhea, vomiting, or abdominal pain)
- Elevated markers of inflammation (eg, ESR, CRP, or procalcitonin)
- No other obvious microbial cause of inflammation, including bacterial sepsis and staphylococcal/streptococcal toxic shock syndromes
- Evidence of SARS-CoV-2 infection
- Any of the following:
- Positive SARS-CoV-2 RT-PCR
- Positive serology
- Positive antigen test
- Contact with an individual with COVID-19
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