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

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.

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

Intensive Care Medicine ◽

10.1007/s00134-010-1932-3 ◽

2010 ◽

Vol 36 (9) ◽

pp. 1616-1617 ◽

Cited By ~ 3

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

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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

BMC Pediatrics ◽

10.1186/s12887-021-02689-x ◽

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.

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Parental perceptions of the impact of COVID-19 restrictions on family-centred care at a paediatric intensive care unit

British Journal of Child Health ◽

10.12968/chhe.2021.2.4.195 ◽

2021 ◽

Vol 2 (4) ◽

pp. 195-200

Author(s):

Kieran Bannerman ◽

Lorna Aitken ◽

Peter Donnelly ◽

Christopher Kidson

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Units ◽

Paediatric Intensive Care Unit ◽

Parental Perceptions ◽

Paediatric Intensive Care ◽

Additional Stress ◽

Free Text ◽

The Impact ◽

Paediatric Intensive Care Units

Background/Aims Restrictions to clinical practice necessitated by the COVID-19 global pandemic exerted pressures on staff, families and patients within the paediatric intensive care unit of the Royal Hospital for Children in Glasgow. The authors sought to explore parents' experiences during this pandemic. Methods A single centre study was performed using a questionnaire distributed to parents of patients in the 22-bed paediatric intensive care unit. The key areas targeted were visiting restrictions, ward round changes, facilities closures and the need to wear personal protective equipment. Free text responses were reviewed by two authors independently and common themes identified. Results The findings offer insight into family perceptions that illustrate the negative repercussions of the restrictions to parents. Understanding on the part of the parents was demonstrated throughout; however, restrictions and pandemic interventions also resulted in isolation, distress, exclusion and anxiety. Conclusions There are no current studies exploring parental perceptions of COVID-19 interventions within paediatric intensive care units. These findings offer insights that illustrate the unique challenges faced by those who strive to deliver family-centred care, and the additional stress that this can put upon parents. The authors propose adaptive strategies to enhance family-centred care at paediatric intensive care units.

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

Journal of the Intensive Care Society ◽

10.1177/1751143717746047 ◽

2018 ◽

Vol 19 (3) ◽

pp. 209-213 ◽

Cited By ~ 2

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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Epidemiology and fungal infection risk factors in patients hospitalized in neonatal and paediatric intensive care units – a multicentre pilot study

Signa Vitae - A Journal In Intensive Care And Emergency Medicine ◽

10.22514/sv112.062016.11 ◽

2016 ◽

Vol 11 (S2) ◽

pp. 51 ◽

Cited By ~ 1

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Pilot Study ◽

Fungal Infection ◽

Intensive Care Units ◽

Infection Risk ◽

Paediatric Intensive Care ◽

Infection Risk Factors ◽

Paediatric Intensive Care Units

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Is there a sex difference in mortality rates for deaths occurring in paediatric intensive care units? Systematic literature review protocol

BMJ Open ◽

10.1136/bmjopen-2020-046794 ◽

2021 ◽

Vol 11 (2) ◽

pp. e046794

Author(s):

Ofran Almossawi ◽

Amanda Friend ◽

Luigi Palla ◽

Richard Feltbower ◽

Bianca De Stavola

Keyword(s):

Intensive Care ◽

Literature Review ◽

Intensive Care Units ◽

Systematic Literature Review ◽

Data Extraction ◽

Linkage Study ◽

Paediatric Intensive Care ◽

Admission Rates ◽

Ethical Approval ◽

Paediatric Intensive Care Units

IntroductionIn the general population, female children have been reported to have a survival advantage. For children admitted to paediatric intensive care units (PICUs), mortality has been reported to be lower in males despite the higher admission rates for males into intensive care. This apparent sex reversal in PICU mortality is not well studied. To address this, we propose to conduct a systematic literature review to summarise the available evidence. Our review will study the reported differences in mortality between males and females aged 0–17, who died in a PICU, to examine if there is a difference between the two sexes in PICU mortality, and if so, to describe the magnitude and direction of this difference.Methods and analysisStudies that directly or indirectly addressed the association between sex and mortality in children admitted to intensive care will be eligible for inclusion. Studies that directly address the association will be eligible for data extraction. The search strings were based on terms related to the population (children in intensive care), the exposure (sex) and the outcome (mortality). We used the databases MEDLINE (1946–2020), Embase (1980–2020) and Web of Science (1985–2020) as these cover relevant clinical publications. We will assess the reliability of included studies using the risk of bias in observational studies of exposures tool. We will consider a pooled effect if we have at least three studies with similar periods of follow up and adjustment variables.Ethics and disseminationEthical approval is not required for this review as it will synthesise data from existing studies. This manuscript is a part of a larger data linkage study, for which Ethical approval was granted. Dissemination will be via peer-reviewed journals and via public and patient groups.PROSPERO registration numberCRD42020203009.

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Evolution of disease transmission during the COVID-19 pandemic: patterns and determinants

Scientific Reports ◽

10.1038/s41598-021-90347-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jie Zhu ◽

Blanca Gallego

Keyword(s):

Public Health ◽

Disease Transmission ◽

Clustering Algorithm ◽

Health Interventions ◽

Transmission Model ◽

Model Parameters ◽

Public Health Interventions ◽

Forecasting Accuracy ◽

Time Lagged ◽

The Impact

AbstractEpidemic models are being used by governments to inform public health strategies to reduce the spread of SARS-CoV-2. They simulate potential scenarios by manipulating model parameters that control processes of disease transmission and recovery. However, the validity of these parameters is challenged by the uncertainty of the impact of public health interventions on disease transmission, and the forecasting accuracy of these models is rarely investigated during an outbreak. We fitted a stochastic transmission model on reported cases, recoveries and deaths associated with SARS-CoV-2 infection across 101 countries. The dynamics of disease transmission was represented in terms of the daily effective reproduction number ($$R_t$$ R t ). The relationship between public health interventions and $$R_t$$ R t was explored, firstly using a hierarchical clustering algorithm on initial $$R_t$$ R t patterns, and secondly computing the time-lagged cross correlation among the daily number of policies implemented, $$R_t$$ R t , and daily incidence counts in subsequent months. The impact of updating $$R_t$$ R t every time a prediction is made on the forecasting accuracy of the model was investigated. We identified 5 groups of countries with distinct transmission patterns during the first 6 months of the pandemic. Early adoption of social distancing measures and a shorter gap between interventions were associated with a reduction on the duration of outbreaks. The lagged correlation analysis revealed that increased policy volume was associated with lower future $$R_t$$ R t (75 days lag), while a lower $$R_t$$ R t was associated with lower future policy volume (102 days lag). Lastly, the outbreak prediction accuracy of the model using dynamically updated $$R_t$$ R t produced an average AUROC of 0.72 (0.708, 0.723) compared to 0.56 (0.555, 0.568) when $$R_t$$ R t was kept constant. Monitoring the evolution of $$R_t$$ R t during an epidemic is an important complementary piece of information to reported daily counts, recoveries and deaths, since it provides an early signal of the efficacy of containment measures. Using updated $$R_t$$ R t values produces significantly better predictions of future outbreaks. Our results found variation in the effect of early public health interventions on the evolution of $$R_t$$ R t over time and across countries, which could not be explained solely by the timing and number of the adopted interventions.

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Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320962 ◽

2021 ◽

pp. archdischild-2020-320962

Author(s):

Ruchi Sinha ◽

Angela Aramburo ◽

Akash Deep ◽

Emma-Jane Bould ◽

Hannah L Buckley ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Clinical Care ◽

Adult Patients ◽

Paediatric Intensive Care ◽

Critically Ill Adults ◽

Care Capacity ◽

Ill Adults ◽

Paediatric Intensive Care Units

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

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