Emergency paediatric critical care in England: describing trends using routine hospital data. Issue 11 (22nd May 2020)

• Record Type: Journal Article
• Authors: Lewis, Kate Marie; Parekh, Sanjay M; Ramnarayan, Padmanabhan; Gilbert, Ruth; Hardelid, Pia; Wijlaars, Linda
• Is Part Of: Archives of disease in childhood. Volume 105:Issue 11(2020)
• Page Start: 1061
• Page End: 1067
• Publication Date: 2020-05-22
• Subjects: epidemiology -- intensive care; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-317902
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objective: To determine trends in emergency admission rates requiring different levels of critical care in hospitals with and without a paediatric intensive care unit (PICU). Design: Birth cohort study created from Hospital Episode Statistics. Setting: National Health Service funded hospitals in England. Patients: 8 577 680 singleton children born between 1 May 2003 and 31 April 2017. Outcome measures: Using procedure and diagnostic codes, we assigned indicators of high dependency care (eg, non-invasive ventilation) or intensive care (eg, invasive ventilation) to emergency admissions. Interventions: Children were followed up until their fifth birthday to estimate high dependency and intensive care admission rates in hospitals with and without a PICU. We tested the yearly trend of high dependency and intensive care admissions to hospitals without a PICU using logistic regression models. Results: Emergency admissions requiring high dependency care in hospitals without a PICU increased from 3.30 (95% CI 3.09 to 3.51) per 10 000 child-years in 2008/2009 to 7.58 (95% CI 7.28 to 7.89) in 2016/2017 and overtook hospitals with a PICU in 2015/2016. The odds of an admission requiring high dependency care to a hospital without a PICU compared with a hospital with a PICU increased by 9% per study year (OR 1.09, 95% CI 1.08 to 1.10). The same trend was not present for admissions requiring intensive care (OR 1.01, 95% CI 0.99 to 1.03). Conclusions: Between 2008/2009 and 2016/2017, an increasing proportion of admissions with indicators of high dependency care took place in hospitals without a PICU.