scholarly journals Is it taking longer to die in paediatric intensive care in England and Wales?

2016 ◽  
Vol 101 (9) ◽  
pp. 798-802 ◽  
Author(s):  
Adrian Plunkett ◽  
Roger C Parslow
Keyword(s):  
Intensive Care ◽  
Severity Of Illness ◽  
Childhood Mortality ◽  
Paediatric Intensive Care ◽  
England And Wales ◽  
Factors Affecting ◽  
Prolongation Of Life ◽  
The Uk ◽  
Paediatric Critical Care ◽  
Paediatric Intensive Care Units

IntroductionAll-cause infant and childhood mortality has decreased in the UK over the last 30 years. Advances in paediatric critical care have increased survival in paediatric intensive care units (PICUs) but may have affected how and when children die in PICU. We explored factors affecting length of stay (LOS) of children who died in PICU over an 11-year period.MethodsWe analysed demographic and clinical data of 165 473 admissions to PICUs in England and Wales, from January 2003 to December 2013. We assessed time trends in LOS for survivors and non-survivors and explored the effect of demographic and clinical characteristics on LOS for non-survivors.ResultsLOS increased 0.310 days per year in non-survivors (95% CI 0.169 to 0.449) and 0.064 days per year in survivors (95% CI 0.046 to 0.083). The proportion of early deaths (<24 h of admission) fell 0.44% points per year (95% CI −0.971 to 0.094), but the proportion of late deaths (>28 days of PICU stay) increased by 0.44% points per year (95% CI 0.185 to 0.691). The paediatric index of mortality score in early deaths increased by 0.77% points per year (95% CI 0.31% to 1.23%).DiscussionIncreased LOS in children who die in PICU is driven by a decreased proportion of early deaths and an increased proportion of late deaths. This trend, combined with an increase in the severity of illness in early deaths, is consistent with a reduction in early mortality for acutely ill children, but a prolongation of life for those children admitted to PICU with life-limiting illnesses.

scholarly journals The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah E. Seaton ◽  
◽  
Elizabeth S. Draper ◽  
Christina Pagel ◽  
Fatemah Rajah ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critical Incidents ◽  
Paediatric Intensive Care ◽  
Junior Doctors ◽  
England And Wales ◽  
The Impact ◽  
Paediatric Critical Care ◽  
Paediatric Intensive Care Units

Abstract Background Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes. Methods We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014–2016) to assess the impact of who led the child’s transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV). Results The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07). Conclusions Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work.

Tracheostomy in children admitted to paediatric intensive care: Table 1

2012 ◽  
Vol 97 (10) ◽  
pp. 866-869 ◽  
Author(s):  
Dora Wood ◽  
Philip McShane ◽  
Peter Davis
Keyword(s):  
Intensive Care ◽  
Death Rate ◽  
Current Practice ◽  
Paediatric Intensive Care ◽  
Invasive Ventilation ◽  
Advantages And Disadvantages ◽  
Bed Days ◽  
The Uk ◽  
Paediatric Intensive Care Units ◽  
Common Intervention

PurposeTracheostomy is a common intervention for adults admitted to intensive care; many are performed early and most are percutaneous. Our study aimed to elucidate current practice and indications for children in the UK admitted to paediatric intensive care and undergoing tracheostomy.DesignA questionnaire covering unit guidelines, practice, and the advantages and disadvantages of tracheostomy was sent to all UK paediatric intensive care units (PICUs) participating in the Paediatric Intensive Care Audit Network (PICANet). These results were combined with data from PICANet on all children in the UK reported to have had a tracheostomy performed during a PICU admission between 2005 and 2009 inclusive.ResultsOver 5 years, 1613 children had tracheostomies performed during their PICU admission (2.05% of all admissions). The death rate was 5.58% with tracheostomy versus 4.72% overall, but differences were not significant when risk-adjusted using the Paediatric Index of Mortality 2 (PIM2). All 29 units participating in PICANet responded to the survey. Prolonged invasive ventilation was an indication for tracheostomy in 25/29 units, but the definition varied between 14 and 90 days, and most respondents considered timing on an individual basis. Children undergoing tracheostomy during PICU admission account for 9% of PICU bed days in the UK.ConclusionsIn contrast with current adult UK practice, tracheostomy for children admitted to intensive care is infrequent, performed late following admission and usually surgical. Practice varies significantly. The death rate for children having a tracheostomy performed was not significantly higher than for children admitted to PICU who did not undergo tracheostomy.

scholarly journals Sex difference in infant mortality: a study of UK Paediatric Intensive Care admissions over 11 years

2020 ◽  
Author(s):  
Ofran Almossawi ◽  
Scott O'Brien ◽  
Roger Parslow ◽  
Simon Nadel ◽  
Luigi Palla
Keyword(s):  
Intensive Care ◽  
Infant Mortality ◽  
Child Mortality ◽  
Significant Proportion ◽  
Severity Of Illness ◽  
Paediatric Intensive Care ◽  
Response To Treatment ◽  
Risk Of Death ◽  
The Uk ◽  
Male To Female

Abstract Rationale Within the UK, child mortality from all causes has declined for all ages over the last three decades. However, distinct inequality remains, as child mortality rates vary by sex and are generally found to be higher in males. A significant proportion of childhood deaths in the UK occur in Paediatric Intensive Care Units (PICU). Objectives We aimed to study the association of sex with infant mortality in PICUs. Methods We obtained data for all infant admissions to UK-PICUs from 01/01/2005 to 31/12/2015. We assessed the causal relationship between sex and mortality and selected appropriate variables for adjustment. We fitted a cause specific hazard ratio (CSHR) model, and a logistic model to estimate the adjusted effect of sex on mortality in PICU. Pre-defined subgroups were children less than 56 days old, and those with a primary diagnosis of infection. Measurements and Main Results Within the 71,243 admissions, there were 1,411/29,520 (4.8%) female deaths, and 1,809/41,723 (4.3%) male deaths. The adjusted male to female CSHR was 0.87 (95%-CI 0.81 to 0.92) representing a 13% higher risk of death for females over males. Similarly, the adjusted OR for male to female mortality is 0.87 (95%-CI, 0.81 to 0.94). Subgroup analysis yielded similar findings. Conclusions Female sex is associated with higher mortality in infants needing PICU admission, despite similar severity of illness to males. There was no effect of age or infection status. This suggests that females and males differ in the pathophysiology of critical illness and/or their response to treatment.

Survey of clinical information system usage by paediatric intensive care units in the UK

2010 ◽  
Vol 36 (9) ◽  
pp. 1616-1617 ◽  
Author(s):  
Krish Thiru ◽  
Stuart Rowe ◽  
Nicola Shaw ◽  
Andrew Durward ◽  
David P. Inwald ◽  
...  
Keyword(s):  
Information System ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Information System ◽  
Clinical Information ◽  
Paediatric Intensive Care ◽  
System Usage ◽  
The Uk ◽  
Paediatric Intensive Care Units

scholarly journals In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Hari Krishnan Kanthimathinathan ◽  
Hannah Buckley ◽  
Peter J. Davis ◽  
Richard G. Feltbower ◽  
Caroline Lamming ◽  
...  
Keyword(s):  
Public Health ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Health Interventions ◽  
Paediatric Intensive Care ◽  
Public Health Interventions ◽  
The Uk ◽  
Unplanned Admissions ◽  
The Impact ◽  
Paediatric Intensive Care Units

Abstract Background The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. Methods We performed a retrospective cohort study of all admissions to PICUs in children < 18 years during Jan–Dec 2020, using data collected from 32 PICUs via a central database (PICANet). Admission patterns, case-mix, resource use, and outcomes were compared with the four preceding years (2016–2019) based on the date of admission. Results There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340–20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016–2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5–3.4) vs. 1.2 (0.5–3.4) %], length of stay [2.3 (1.0–5.5) vs. 2.4 (1.0–5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91–1.11, p = 0.93])] were similar between 2016–2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016–2019 (n = 711). Conclusions The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.

Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate

2017 ◽  
Vol 103 (4) ◽  
pp. 341-345 ◽  
Author(s):  
Peter Davis ◽  
Christopher Stutchfield ◽  
T Alun Evans ◽  
Elizabeth Draper
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
South Asian ◽  
Population Data ◽  
Paediatric Intensive Care ◽  
Additional Increase ◽  
England And Wales ◽  
Asian Ethnicity ◽  
Increased Risk ◽  
Paediatric Intensive Care Units

ObjectiveTo determine the number of individual children admitted to Paediatric Intensive Care Units (PICUs) in England and Wales between 2004 and 2013 and to investigate potential factors for any change over time, including ethnicity.MethodsAnonymised demographic and epidemiological data were extracted from the Paediatric Intensive Care Audit Network (PICANet) database and analysed for all children resident in England and Wales admitted to PICUs of National Health Service (NHS) hospitals in those countries between 2004 and 2013. Population data, including births, were obtained from the Office of National Statistics and analysed. Predicted numbers of children admitted to PICU were compared with actual admissions, averaged over 3-year periods.ResultsIncreasing numbers of individual children were admitted to PICUs in England and Wales between 2004 and 2013. The largest increases were among younger children (0–5 years) and those with primary respiratory or cardiac diagnoses. They were also greatest in regions with the most mothers born overseas. From 2009 onwards, more children were admitted to PICUs than predicted, separate from overall population growth, South Asian ethnicity or requirement for ventilation.ConclusionsAn additional increase in the number of children from England and Wales admitted to PICU from 2009 onwards is not explained by a rising child population or an increased risk of admission among South Asian children. There was no evidence of a reduction in the admission criteria to PICUs. Given healthcare funding in England and Wales, continued increases would present a challenging prospect for both providers and commissioners of these services.

scholarly journals Characteristics of adolescents requiring intensive care in the United Kingdom: A retrospective cohort study

2018 ◽  
Vol 19 (3) ◽  
pp. 209-213 ◽  
Author(s):  
Dora Wood ◽  
Sarah Goodwin ◽  
John Pappachan ◽  
Peter Davis ◽  
Roger Parslow ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Intensive Care Unit Mortality ◽  
Elective Surgery ◽  
Paediatric Intensive Care ◽  
Adult Intensive Care Unit ◽  
The United Kingdom ◽  
The Uk ◽  
Paediatric Intensive Care Units

Objectives To describe the case mix, resource use and outcomes for adolescents admitted to intensive care units in the UK. Methods Analysis of national prospectively collected data for all adolescents aged 12–19 years admitted to UK adult or paediatric intensive care units. Results There were 37,320 admissions of adolescents during the eight–year study period. Excluding elective surgery, respiratory diagnoses were the most common reason for paediatric intensive care unit (PICU) admission, with trauma and intoxication the most common reasons for adult intensive care unit (AICU) admission. Intensive care unit mortality was 6.0% and 5.7% for those admitted to PICUs and AICUs, respectively. Conclusions Mortality is similar among adolescents admitted to AICUs and PICUs; however, these rates have not been corrected for severity of acute illness or underlying burden of chronic illness, which may be different between AICUs and PICUs. Services planned for the majority of AICU and PICU patients may not be optimal for critically ill adolescents treated in UK intensive care units, who may need special consideration.

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