Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study

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Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK : a multicentre observational study. / Davies, Patrick; Evans, Claire; Kanthimathinathan, Hari Krishnan; Lillie, Jon; Brierley, Joseph; Waters, Gareth; Johnson, Mae; Griffiths, Benedict; du Pré, Pascale; Mohammad, Zoha; Deep, Akash; Playfor, Stephen; Singh, Davinder; Inwald, David; Jardine, Michelle; Ross, Oliver; Shetty, Nayan; Worrall, Mark; Sinha, Ruchi; Koul, Ashwani; Whittaker, Elizabeth; Vyas, Harish; Scholefield, Barnaby R; Ramnarayan, Padmanabhan.

In: The Lancet Child & Adolescent Health, Vol. 4, No. 9, 09.2020, p. 669-677.

Research output: Contribution to journalArticlepeer-review

Harvard

Davies, P, Evans, C, Kanthimathinathan, HK, Lillie, J, Brierley, J, Waters, G, Johnson, M, Griffiths, B, du Pré, P, Mohammad, Z, Deep, A, Playfor, S, Singh, D, Inwald, D, Jardine, M, Ross, O, Shetty, N, Worrall, M, Sinha, R, Koul, A, Whittaker, E, Vyas, H, Scholefield, BR & Ramnarayan, P 2020, 'Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study', The Lancet Child & Adolescent Health, vol. 4, no. 9, pp. 669-677. https://doi.org/10.1016/S2352-4642(20)30215-7

APA

Davies, P., Evans, C., Kanthimathinathan, H. K., Lillie, J., Brierley, J., Waters, G., Johnson, M., Griffiths, B., du Pré, P., Mohammad, Z., Deep, A., Playfor, S., Singh, D., Inwald, D., Jardine, M., Ross, O., Shetty, N., Worrall, M., Sinha, R., ... Ramnarayan, P. (2020). Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. The Lancet Child & Adolescent Health, 4(9), 669-677. https://doi.org/10.1016/S2352-4642(20)30215-7

Vancouver

Author

Davies, Patrick ; Evans, Claire ; Kanthimathinathan, Hari Krishnan ; Lillie, Jon ; Brierley, Joseph ; Waters, Gareth ; Johnson, Mae ; Griffiths, Benedict ; du Pré, Pascale ; Mohammad, Zoha ; Deep, Akash ; Playfor, Stephen ; Singh, Davinder ; Inwald, David ; Jardine, Michelle ; Ross, Oliver ; Shetty, Nayan ; Worrall, Mark ; Sinha, Ruchi ; Koul, Ashwani ; Whittaker, Elizabeth ; Vyas, Harish ; Scholefield, Barnaby R ; Ramnarayan, Padmanabhan. / Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK : a multicentre observational study. In: The Lancet Child & Adolescent Health. 2020 ; Vol. 4, No. 9. pp. 669-677.

Bibtex

@article{a569577914e545bc8692aedd3601f12e,
title = "Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study",
abstract = "Background: In April, 2020, clinicians in the UK observed a cluster of children with unexplained inflammation requiring admission to paediatric intensive care units (PICUs). We aimed to describe the clinical characteristics, course, management, and outcomes of patients admitted to PICUs with this condition, which is now known as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Methods: We did a multicentre observational study of children (aged <18 years), admitted to PICUs in the UK between April 1 and May 10, 2020, fulfilling the case definition of PIMS-TS published by the Royal College of Paediatrics and Child Health. We analysed routinely collected, de-identified data, including demographic details, presenting clinical features, underlying comorbidities, laboratory markers, echocardiographic findings, interventions, treatments, and outcomes; serology information was collected if available. PICU admission rates of PIMS-TS were compared with historical trends of PICU admissions for four similar inflammatory conditions (Kawasaki disease, toxic shock syndrome, haemophagocytic lymphohistiocytosis, and macrophage activation syndrome). Findings: 78 cases of PIMS-TS were reported by 21 of 23 PICUs in the UK. Historical data for similar inflammatory conditions showed a mean of one (95% CI 0·85–1·22) admission per week, compared to an average of 14 admissions per week for PIMS-TS and a peak of 32 admissions per week during the study period. The median age of patients was 11 years (IQR 8–14). Male patients (52 [67%] of 78) and those from ethnic minority backgrounds (61 [78%] of 78) were over-represented. Fever (78 [100%] patients), shock (68 [87%]), abdominal pain (48 [62%]), vomiting (49 [63%]), and diarrhoea (50 [64%]) were common presenting features. Longitudinal data over the first 4 days of admission showed a serial reduction in C-reactive protein (from a median of 264 mg/L on day 1 to 96 mg/L on day 4), D-dimer (4030 μg/L to 1659 μg/L), and ferritin (1042 μg/L to 757 μg/L), whereas the lymphocyte count increased to more than 1·0 × 10 9 cells per L by day 3 and troponin increased over the 4 days (from a median of 157 ng/mL to 358 ng/mL). 36 (46%) of 78 patients were invasively ventilated and 65 (83%) needed vasoactive infusions; 57 (73%) received steroids, 59 (76%) received intravenous immunoglobulin, and 17 (22%) received biologic therapies. 28 (36%) had evidence of coronary artery abnormalities (18 aneurysms and ten echogenicity). Three children needed extracorporeal membrane oxygenation, and two children died. Interpretation: During the study period, the rate of PICU admissions for PIMS-TS was at least 11-fold higher than historical trends for similar inflammatory conditions. Clinical presentations and treatments varied. Coronary artery aneurysms appear to be an important complication. Although immediate survival is high, the long-term outcomes of children with PIMS-TS are unknown. Funding: None. ",
keywords = "Adolescent, Betacoronavirus, Child, Coronavirus Infections/complications, Female, Humans, Incidence, Intensive Care Units, Pediatric/statistics & numerical data, Male, Pandemics, Patient Admission/trends, Pneumonia, Viral/complications, Systemic Inflammatory Response Syndrome/epidemiology, United Kingdom/epidemiology",
author = "Patrick Davies and Claire Evans and Kanthimathinathan, {Hari Krishnan} and Jon Lillie and Joseph Brierley and Gareth Waters and Mae Johnson and Benedict Griffiths and {du Pr{\'e}}, Pascale and Zoha Mohammad and Akash Deep and Stephen Playfor and Davinder Singh and David Inwald and Michelle Jardine and Oliver Ross and Nayan Shetty and Mark Worrall and Ruchi Sinha and Ashwani Koul and Elizabeth Whittaker and Harish Vyas and Scholefield, {Barnaby R} and Padmanabhan Ramnarayan",
year = "2020",
month = sep,
doi = "10.1016/S2352-4642(20)30215-7",
language = "English",
volume = "4",
pages = "669--677",
journal = "The Lancet Child & Adolescent Health",
issn = "2352-4642",
publisher = "Elsevier",
number = "9",

}

RIS

TY - JOUR

T1 - Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK

T2 - a multicentre observational study

AU - Davies, Patrick

AU - Evans, Claire

AU - Kanthimathinathan, Hari Krishnan

AU - Lillie, Jon

AU - Brierley, Joseph

AU - Waters, Gareth

AU - Johnson, Mae

AU - Griffiths, Benedict

AU - du Pré, Pascale

AU - Mohammad, Zoha

AU - Deep, Akash

AU - Playfor, Stephen

AU - Singh, Davinder

AU - Inwald, David

AU - Jardine, Michelle

AU - Ross, Oliver

AU - Shetty, Nayan

AU - Worrall, Mark

AU - Sinha, Ruchi

AU - Koul, Ashwani

AU - Whittaker, Elizabeth

AU - Vyas, Harish

AU - Scholefield, Barnaby R

AU - Ramnarayan, Padmanabhan

PY - 2020/9

Y1 - 2020/9

N2 - Background: In April, 2020, clinicians in the UK observed a cluster of children with unexplained inflammation requiring admission to paediatric intensive care units (PICUs). We aimed to describe the clinical characteristics, course, management, and outcomes of patients admitted to PICUs with this condition, which is now known as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Methods: We did a multicentre observational study of children (aged <18 years), admitted to PICUs in the UK between April 1 and May 10, 2020, fulfilling the case definition of PIMS-TS published by the Royal College of Paediatrics and Child Health. We analysed routinely collected, de-identified data, including demographic details, presenting clinical features, underlying comorbidities, laboratory markers, echocardiographic findings, interventions, treatments, and outcomes; serology information was collected if available. PICU admission rates of PIMS-TS were compared with historical trends of PICU admissions for four similar inflammatory conditions (Kawasaki disease, toxic shock syndrome, haemophagocytic lymphohistiocytosis, and macrophage activation syndrome). Findings: 78 cases of PIMS-TS were reported by 21 of 23 PICUs in the UK. Historical data for similar inflammatory conditions showed a mean of one (95% CI 0·85–1·22) admission per week, compared to an average of 14 admissions per week for PIMS-TS and a peak of 32 admissions per week during the study period. The median age of patients was 11 years (IQR 8–14). Male patients (52 [67%] of 78) and those from ethnic minority backgrounds (61 [78%] of 78) were over-represented. Fever (78 [100%] patients), shock (68 [87%]), abdominal pain (48 [62%]), vomiting (49 [63%]), and diarrhoea (50 [64%]) were common presenting features. Longitudinal data over the first 4 days of admission showed a serial reduction in C-reactive protein (from a median of 264 mg/L on day 1 to 96 mg/L on day 4), D-dimer (4030 μg/L to 1659 μg/L), and ferritin (1042 μg/L to 757 μg/L), whereas the lymphocyte count increased to more than 1·0 × 10 9 cells per L by day 3 and troponin increased over the 4 days (from a median of 157 ng/mL to 358 ng/mL). 36 (46%) of 78 patients were invasively ventilated and 65 (83%) needed vasoactive infusions; 57 (73%) received steroids, 59 (76%) received intravenous immunoglobulin, and 17 (22%) received biologic therapies. 28 (36%) had evidence of coronary artery abnormalities (18 aneurysms and ten echogenicity). Three children needed extracorporeal membrane oxygenation, and two children died. Interpretation: During the study period, the rate of PICU admissions for PIMS-TS was at least 11-fold higher than historical trends for similar inflammatory conditions. Clinical presentations and treatments varied. Coronary artery aneurysms appear to be an important complication. Although immediate survival is high, the long-term outcomes of children with PIMS-TS are unknown. Funding: None.

AB - Background: In April, 2020, clinicians in the UK observed a cluster of children with unexplained inflammation requiring admission to paediatric intensive care units (PICUs). We aimed to describe the clinical characteristics, course, management, and outcomes of patients admitted to PICUs with this condition, which is now known as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Methods: We did a multicentre observational study of children (aged <18 years), admitted to PICUs in the UK between April 1 and May 10, 2020, fulfilling the case definition of PIMS-TS published by the Royal College of Paediatrics and Child Health. We analysed routinely collected, de-identified data, including demographic details, presenting clinical features, underlying comorbidities, laboratory markers, echocardiographic findings, interventions, treatments, and outcomes; serology information was collected if available. PICU admission rates of PIMS-TS were compared with historical trends of PICU admissions for four similar inflammatory conditions (Kawasaki disease, toxic shock syndrome, haemophagocytic lymphohistiocytosis, and macrophage activation syndrome). Findings: 78 cases of PIMS-TS were reported by 21 of 23 PICUs in the UK. Historical data for similar inflammatory conditions showed a mean of one (95% CI 0·85–1·22) admission per week, compared to an average of 14 admissions per week for PIMS-TS and a peak of 32 admissions per week during the study period. The median age of patients was 11 years (IQR 8–14). Male patients (52 [67%] of 78) and those from ethnic minority backgrounds (61 [78%] of 78) were over-represented. Fever (78 [100%] patients), shock (68 [87%]), abdominal pain (48 [62%]), vomiting (49 [63%]), and diarrhoea (50 [64%]) were common presenting features. Longitudinal data over the first 4 days of admission showed a serial reduction in C-reactive protein (from a median of 264 mg/L on day 1 to 96 mg/L on day 4), D-dimer (4030 μg/L to 1659 μg/L), and ferritin (1042 μg/L to 757 μg/L), whereas the lymphocyte count increased to more than 1·0 × 10 9 cells per L by day 3 and troponin increased over the 4 days (from a median of 157 ng/mL to 358 ng/mL). 36 (46%) of 78 patients were invasively ventilated and 65 (83%) needed vasoactive infusions; 57 (73%) received steroids, 59 (76%) received intravenous immunoglobulin, and 17 (22%) received biologic therapies. 28 (36%) had evidence of coronary artery abnormalities (18 aneurysms and ten echogenicity). Three children needed extracorporeal membrane oxygenation, and two children died. Interpretation: During the study period, the rate of PICU admissions for PIMS-TS was at least 11-fold higher than historical trends for similar inflammatory conditions. Clinical presentations and treatments varied. Coronary artery aneurysms appear to be an important complication. Although immediate survival is high, the long-term outcomes of children with PIMS-TS are unknown. Funding: None.

KW - Adolescent

KW - Betacoronavirus

KW - Child

KW - Coronavirus Infections/complications

KW - Female

KW - Humans

KW - Incidence

KW - Intensive Care Units, Pediatric/statistics & numerical data

KW - Male

KW - Pandemics

KW - Patient Admission/trends

KW - Pneumonia, Viral/complications

KW - Systemic Inflammatory Response Syndrome/epidemiology

KW - United Kingdom/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85088360082&partnerID=8YFLogxK

UR - https://europepmc.org/article/med/32653054

U2 - 10.1016/S2352-4642(20)30215-7

DO - 10.1016/S2352-4642(20)30215-7

M3 - Article

C2 - 32653054

VL - 4

SP - 669

EP - 677

JO - The Lancet Child & Adolescent Health

JF - The Lancet Child & Adolescent Health

SN - 2352-4642

IS - 9

ER -