Differences in Paediatric intensive care mortality by biological sex: a study of English PICUs using linked…

Cohort studyIntensive care medicine. Paediatric and neonatal· 2026

Differences in Paediatric intensive care mortality by biological sex: a study of English PICUs using linked administrative datasets.

Ofran Almossawi, Bianca L De Stavola, Katie Harron … Simon Nadel

Pediatric Critical & Emergency CareCohort studyQ1IF 5.7

Girls have higher mortality than boys in pediatric intensive care, unlike the general population

Differences in Paediatric intensive care mortality by biological sex: a study of English PICUs using linked administrative datasets.

Ofran Almossawi … Simon Nadel

Intensive care medicine · 2026

Purpose

To determine if there is a causal relationship between sex and mortality in Paediatric Intensive Care Units (Paediatric Intensive Care Units).

Methods

Were children aged 0 to 8 years with at least one admission to Paediatric Intensive Care Units between January 2010 and December 2019, with linked Paediatric Intensive Care Units and hospital records.

n = 48,500 children

Results

girls in picu had higher excess death risk than boys, reversing the usual pattern

RD 0.31 (95% CI 0.01 to 0.61)

null 0

0.01

0.61

CI excludes the null - significant

More results

There were 48,500 children, of whom 20,412 (42.1%) were females and 28,088 (57.9%) were males and with a median age at first Paediatric Intensive Care Units admission of 0.5 (IQR 0.08-2.02) years.

During the first admission, 1,760 (3.63%) children died; of whom, 777/20,412 (3.81%) were female and 983/28,088 (3.50%) were male.

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Conclusion · 1 of 4

Although boys have a higher rate of death than girls by age in the general population, this mortality trend is reversed in Paediatric Intensive Care Units.

Conclusion · 2 of 4

Evidence of this increased female mortality persists after applying doubly robust causal methods, indicating a causal link.

Conclusion · 3 of 4

The supposition that all pre-pubertal children have the same responses to critical illness and their management should be re-examined.

Conclusion · 4 of 4

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s44253-026-00130-8.

Differences in Paediatric intensive care mortality by biological sex: a study of English PICUs using linked administrative datasets.

Differences in Paediatric intensive care mortality by biological sex: a study of English PICUs using linked administrative datasets.

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