CARDIAC Score: A Framework for a Clinical Tool to Screen and Risk Stratify Pediatric Myocarditis, and Call for Collaboration to Evaluate Use

There are no clinical decision-making tools to screen for pediatric myocarditis during initial evaluation in the current literature, so we aim to create one using the CARDIAC score. The CARDIAC score is an acronym of its six components: chest X-ray, appearance, risk factors/clinical signs, diagnostics, interventions, abnormal tachycardia, and cardiac markers and C-reactive protein (CRP). Each of these may be scored with 0, 1, or 2 points, with diagnostics and interventions having a third point available to score if the patient meets multiple requirements (i.e., both abnormal electrocardiogram and cardiac point-of-care ultrasound results for diagnostics criteria or requires both respiratory and blood pressure support for interventions required criteria). This is a framework for the proposed CARDIAC score to screen for pediatric myocarditis and risk-stratify patients based on severity and need for further evaluation with echocardiogram, pediatric cardiology consultation, possible cardiac MRI/biopsy, and evaluation for additional interventions such as ECMO (extracorporeal membrane oxygenation) or heart transplantation by a pediatric tertiary or quaternary center. This is a protocol that has not yet been validated and should not be used in clinical practice until validation studies can confirm or reject its utilization.