Background Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) emerged as a novel condition causing serious illness in affected children, in late April 2020. Multi-organ involvement with systemic, cutaneous, gastrointestinal and cardiac features and clinical overlap with conditions like sepsis, toxic shock syndrome and Kawasaki disease (KD) and have led to delays in recognition of PIMS-TS. Objectives We evaluated the clinical characteristics and reattendance rates of children presenting to urgent care facilities [(primary care or Emergency Department (ED)] prior to definitive hospital admission. Methods An observational study using retrospective data collection was undertaken on children with a diagnosis of PIMSTS, who presented to a specialist children's hospital, between 1st April 2020 and 17th May 2020. Diagnosis of PIMS-TS was based on published RCPCH criteria1 Reattendance rates, patient demographics, initial presenting features and subsequent progress was assessed Results Eighteen children were included in the study (median 9.6 years;IQR 7-12.6 years). All children required high dependency or intensive care treatment. 89% (n=16) required fluid resuscitation and inotropes with 17% (n=3) requiring invasive ventilatory support. In this cohort, 39% (n=7) were first assessed by a primary care physician and 61% (n=11) presented to ED. Overall, 89% (n=16) of the children were discharged after initial presentation and subsequently reattended with worsening symptoms. Only 11% were admitted at first presentation. Of the study population, 22% (n=4) received advice from either 111 or 999 before attending GP or ED. The majority of reattenders (88%) were admitted during their third attendance and 12% were admitted at their sixth attendance. All children (100%) presented with fever above 38.5°C with a median duration of 3 (range 1-5) days. Gastrointestinal symptoms at presentation included abdominal pain in fifteen children (83%), vomiting in eleven children (61%) and diarrhoea in thirteen children (72%). Syncope was reported in six children (33%) and lethargy in fourteen children (77%). Muco-cutaneous features of rash and conjunctivitis resembling KD, were seen in eleven children (61%). Other symptoms at presentation were oedema (38%), myalgia (61%), headache (38%), neck pain six (33%) and sore throat (33%). Conclusions Children with PIMS-TS were older (above 9 years) and presented with persistent high-grade fever, hypotension, gastrointestinal and muco-cutaneous features. High reattendance rates were seen in our cohort of children with PIMS-TS. While this could indicate the natural course of evolution of the condition, prolonged duration of fever in an older age group and requirement of fluid resuscitation at admission suggests a missed opportunity for earlier recognition and intervention. UK data of median of 5 days interval between presentation and referral for KD, suggests a similar delayed recognition of PIMSTS, due to the multi-system features and overlap with childhood infections. A high index of suspicion of PIMSTS and lower thresholds for admission in children presenting with these features to urgent care facilities in the current pandemic, will help institute early definitive treatment, thus reducing morbidity.