Measurements and Main Results: De-identified data collected as part of routine clinical care was analysed. All children were diagnosed and staged for AKI based on the level of serum creatinine above the upper limit of reference interval (ULRI) values according to published guidance. Severe AKI was defined as stage 2/3 AKI. Uni-and multi-variable analyses were performed to study the association between demographic data, clinical features, markers of inflammation and cardiac injury, and severe AKI. Over the study period, 116 patients with PIMS-TS were admitted to 15 UK PICUs. Any-stage AKI occurred in 48/116 patients (41.4%), and severe AKI in 32/116 (27.6%) patients, which was mostly evident at admission (24/32, 75%). In univariable analysis, body mass index, hyperferritinemia, high C-reactive protein (CRP), Pediatric Index of Mortality 3 (PIM3) score, vasoactive medication and invasive mechanical ventilation (IMV) were associated with severe AKI. In multivariable logistic regression, hyperferritinemia was associated with severe AKI (compared to non-severe AKI, adjusted odds ratio 1.04, 95% CI 1.01-1.08, p=0.04). Severe AKI was associated with longer PICU stay (median 5 days [IQR 4,7] vs 3 days [IQR 1.5,5], p<0.001) and increased duration of IMV (median 4 days [IQR 2,6] vs 2 days [IQR 1,3], p=0.04). Conclusions: Severe AKI occurred in just over a quarter of children admitted to UK PICUs with PIMS-TS. Hyperferritinemia was significantly associated with severe AKI. Severe AKI was associated with increased duration of stay and ventilation. Although short-term outcomes for AKI in PIMS-TS appear good, long-term outcomes are unknown.

To compare the prevalence of adverse events related to vasoactive drug infusions administered via a peripheral venous catheter versus a central venous or intraosseous catheter.DESIGN: Retrospective observational study. SETTING:A pediatric critical care transport team, and the PICUs and regional hospitals within the North Thames and East Anglia regions of the United Kingdom. PATIENTS:Children (up to 18 yr old) transported by the Children's Acute Transport Service receiving an infusion of a vasoactive drug (epinephrine, dobutamine, dopamine, norepinephrine, and vasopressin). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:The medical records of all children transported between April 2017 and May 2020 receiving a vasoactive drug infusion were reviewed and cross-referenced with the service critical incident database. The outcome measure was anatomic catheter-related adverse events (including extravasation) reported during transport or in the first 24 hours on the PICU. During the study period, the service undertook 3,836 transports. Vasoactive drugs were administered during 558 patient transports (14.5%). During 198 of 558 transports (35.5%), vasoactive drugs were administered via a peripheral venous catheter, with seven of 198 (3.5%) adverse events. One extravasation event resulted in tissue necrosis. The median time to injury after the infusion was commenced was 60 minutes (interquartile range, 30-60 min). During 360 of 558 transports (64.5%), vasoactive infusions were administered by central venous or intraosseous catheter, with nine of 360 (2.5%) adverse events. CONCLUSIONS:During pediatric critical care transport, we did not find a difference in prevalence of adverse events following the administration of vasoactive drugs via peripheral venous catheters or via central venous and intraosseous catheters.

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