Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year

Joseph L. Ward*, Rachel Harwood, Clare Smith, Simon Kenny, Matthew Clark, Peter J. Davis, Elizabeth S. Draper, Dougal Hargreaves, Shamez Ladhani, Michael Linney, Karen Luyt, Steve Turner, Elizabeth Whittaker, Lorna K. Fraser, Russell M. Viner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

66 Citations (Scopus)


Identifying which children and young people (CYP) are most vulnerable to serious infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important to guide protective interventions. To address this question, we used data for all hospitalizations in England among 0–17 year olds from 1 February 2019 to 31 January 2021. We examined how sociodemographic factors and comorbidities might be risk factors for pediatric intensive care unit (PICU) admission among hospitalizations due to the following causes: Coronavirus Disease 2019 (COVID-19) and pediatric inflammatory multi-system syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the first pandemic year (2020–2021); hospitalizations due to all other non-traumatic causes in 2020–2021; hospitalizations due to all non-traumatic causes in 2019–2020; and hospitalizations due to influenza in 2019–2020. Risk of PICU admission and death from COVID-19 or PIMS-TS in CYP was very low. We identified 6,338 hospitalizations with COVID-19, of which 259 were admitted to a PICU and eight CYP died. We identified 712 hospitalizations with PIMS-TS, of which 312 were admitted to a PICU and fewer than five CYP died. Hospitalizations with COVID-19 and PIMS-TS were more common among males, older CYP, those from socioeconomically deprived neighborhoods and those who were of non-White ethnicity (Black, Asian, Mixed or Other). The odds of PICU admission were increased in CYP younger than 1 month old and decreased among 15–17 year olds compared to 1–4 year olds with COVID-19; increased in older CYP and females with PIMS-TS; and increased for Black compared to White ethnicity in patients with COVID-19 and PIMS-TS. Odds of PICU admission in COVID-19 were increased for CYP with comorbidities and highest for CYP with multiple medical problems. Increases in odds of PICU admission associated with different comorbidities in COVID-19 showed a similar pattern to other causes of hospitalization examined and, thus, likely reflect background vulnerabilities. These findings identify distinct risk factors associated with PICU admission among CYP with COVID-19 or PIMS-TS that might aid treatment and prevention strategies.

Original languageEnglish
Pages (from-to)193-200
Number of pages8
JournalNature Medicine
Issue number1
Early online date20 Dec 2021
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information: We would like to thank the National Child Mortality Database; the Paediatric Intensive Care Audit Network; Public Health England; NHS Digital; NHS England; and the NHS Improvement Children and Young People Team, particularly R. Owen, S. Solti, T. Watson-Koszel, M. Ambia, C. Styles and A. Wojciechowska, for their support in identifying, linking and making the data used in this study available for analysis. J.L.W. is in receipt of a Medical Research Council fellowship (grant no. MR/R00160X/1). R.H. is in receipt of a fellowship from Kidney Research UK (grant no. TF_010_20171124). L.K.F. is in receipt of funding from Martin House Children’s Hospice (there is no specific grant number for this). R.M.V. is in receipt of a grant from the National Institute of Health Research to support this work (grant no. NIHR202322). D.H. is supported by the National Institute for Health Research through the National School for Public Health Research Programme and the Applied Health Research Programme for North West London. Funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.

Open Access: Free to read, but no Open Access licence.

Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Nature America, Inc.

Citation: Ward, J.L., Harwood, R., Smith, C. et al. Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year. Nat Med 28, 193–200 (2022).

DOI: https://doi.org/10.1038/s41591-021-01627-9


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