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.

scholarly journals A study of sex difference in infant mortality in UK pediatric intensive care admissions over an 11-year period

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ofran Almossawi ◽  
Scott O’Brien ◽  
Roger Parslow ◽  
Simon Nadel ◽  
Luigi Palla
Keyword(s):  
Intensive Care ◽  
Infant Mortality ◽  
Child Mortality ◽  
Significant Proportion ◽  
Pediatric Intensive Care ◽  
Primary Diagnosis ◽  
Paediatric Intensive Care ◽  
Risk Of Death ◽  
The Uk ◽  
Adjusted Association

AbstractWithin 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 are generally found to be higher in males. A significant proportion of childhood deaths in the UK occur in Paediatric Intensive Care Units (PICU). We studied the association of sex with infant mortality in PICUs. We included all infants (0 to 12 months old) admitted to UK PICUs from 01/01/2005 to 31/12/2015 using the Paediatric Intensive Care Audit Network (PICANet) dataset. We considered first admissions to PICU and fitted a cause-specific-hazard-ratio (CSHR) model, and a logistic model to estimate the adjusted association between sex and mortality in PICU. Pre-defined subgroups were children less than 56-days old, and those with a primary diagnosis of infection. Of 71,243 cases, 1,411/29,520 (4.8%) of females, and 1,809/41,723 (4.3%) of males died. The adjusted male/female CSHR was 0.87 (95%-CI 0.81 to 0.92) representing a 13% higher risk of death for females. The adjusted OR for male to female mortality is 0.86 (95%-CI 0.80 to 0.93). Analyses in subgroups yielded similar findings. In our analysis, female infants have a higher rate of PICU mortality compared to male infants.

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.

‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

2021 ◽  
pp. 147775092110366
Author(s):  
Harika Avula ◽  
Mariana Dittborn ◽  
Joe Brierley
Keyword(s):  
Intensive Care ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
General Setting ◽  
Daily Practice ◽  
Paediatric Intensive Care ◽  
Ethical Challenges ◽  
Legal Cases ◽  
Ethics Support ◽  
The Uk

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

scholarly journals Correction to: Paediatric intensive care admission blood pressure and risk of death in 30,334 children

2019 ◽  
Vol 45 (10) ◽  
pp. 1500-1501
Author(s):  
A. Matettore ◽  
S. Ray ◽  
D. A. Harrison ◽  
T. Brick ◽  
D. Macrae ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care ◽  
Paediatric Intensive Care ◽  
Intensive Care Admission ◽  
Risk Of Death

scholarly journals Outcomes in Paediatric Intensive Care Units for Children with Life-Limiting Conditions: A national data linkage study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Lorna Fraser ◽  
Sarah Fleming ◽  
Roger Parslow
Keyword(s):  
Intensive Care ◽  
Demographic Data ◽  
Poor Quality ◽  
Linkage Study ◽  
Study Data ◽  
Paediatric Intensive Care ◽  
Health And Social Care ◽  
Group Sex ◽  
Limiting Condition ◽  
The Uk

ABSTRACT ObjectiveTo identify children with a Life-Limiting Condition (LLC) who have had an admission to a Paediatric Intensive Care Unit (PICU) in England and their outcomes. ApproachData for all children who had had a PICU admission in the UK between 1st Jan 2004 and 31st March 2015 were identified from the PICANet dataset. Linkage to inpatient Hospital Episode Statistics (HES) data was undertaken by the NHS Health and Social Care Information Centre for all children who had been resident in England. Their standard algorithm using NHS number, date of birth, sex and postcode was used. All inpatient HES episodes from the financial years 1997/98-2014/15 were received. Although the data quality is high in the PICANet dataset, comorbidities are variably coded therefore identifying whether a child has a LLC or not is not possible. A previously developed ICD10 coding framework was used to identify individuals with one or more of these LLC codes in the inpatient HES dataset. ResultsA total of 199,548 PICU admissions in the UK for 135,759 individuals occurred during the time period of the study. Data for 43,565 admissions (32,025 individuals) were excluded due to not having been resident in England or poor quality demographic data. Data on 103,734 individuals (155,983 admissions) were sent for linkage. Successful linkage occurred in 102,722 individuals (99.4%). Individuals who could not be linked were excluded from the analysis.51.0% of these children had a LLC and these children accounted for 62.7% of the PICU admissions. The crude PICU death rate in the children with a LLC was 5.0% (n=4826) compared to 3.1% (n=1786) in those without a LLC. The OR of death in a model adjusted for diagnostic group, sex, age, and expected risk of mortality for children with a LLC was 2.11 (95%CI 1.97-2.27). ConclusionsChildren with a LLC account for a large proportion of all PICU admissions in England. Although only one in twenty of these children die in PICU, as death may be expected in this population of children more integration of specialist palliative care with PICU services may allow more choice for children and families.

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 Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

2010 ◽  
Vol 31 (11) ◽  
pp. 1106-1114 ◽  
Author(s):  
Adrian G. Barnett ◽  
Nicholas Graves ◽  
Victor D. Rosenthal ◽  
Reinaldo Salomao ◽  
Manuel Sigfrido Rangel-Frausto
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infection ◽  
Latin American ◽  
Severity Of Illness ◽  
Central Line ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk ◽  
Latin American Countries

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.

scholarly journals Children with life-limiting conditions in paediatric intensive care units: a national cohort, data linkage study

2017 ◽  
Vol 103 (6) ◽  
pp. 540-547 ◽  
Author(s):  
Lorna K Fraser ◽  
Roger Parslow
Keyword(s):  
Intensive Care ◽  
Data Linkage ◽  
International Classification Of Diseases ◽  
Linkage Study ◽  
Paediatric Intensive Care ◽  
Risk Of Death ◽  
Paediatric Palliative Care ◽  
Cohort Data ◽  
Palliative Care Services ◽  
National Cohort

ObjectiveTo determine how many children are admitted to paediatric intensive care unit (PICU) with life-limiting conditions (LLCs) and their outcomes.DesignNational cohort, data-linkage study.SettingPICUs in England.PatientsChildren admitted to a UK PICU (1 January 2004 and 31 March 2015) were identified in the Paediatric Intensive Care Audit Network dataset. Linkage to hospital episodes statistics enabled identification of children with a LLC using an International Classification of Diseases (ICD10) code list.Main outcome measuresRandom-effects logistic regression was undertaken to assess risk of death in PICU. Flexible parametric survival modelling was used to assess survival in the year after discharge.ResultsOverall, 57.6% (n=89 127) of PICU admissions and 72.90% (n=4821) of deaths in PICU were for an individual with a LLC.The crude mortality rate in PICU was 5.4% for those with a LLC and 2.7% of those without a LLC. In the fully adjusted model, children with a LLC were 75% more likely than those without a LLC to die in PICU (OR 1.75 (95% CI 1.64 to 1.87)).Although overall survival to 1 year postdischarge was 96%, children with a LLC were 2.5 times more likely to die in that year than children without a LLC (OR 2.59 (95% CI 2.47 to 2.71)).ConclusionsChildren with a LLC accounted for a large proportion of the PICU population. There is an opportunity to integrate specialist paediatric palliative care services with paediatric critical care to enable choice around place of care for these children and families.

scholarly journals A UK and Irish survey of enteral nutrition practices in paediatric intensive care units

2012 ◽  
Vol 109 (7) ◽  
pp. 1304-1322 ◽  
Author(s):  
Lyvonne Tume ◽  
Bernie Carter ◽  
Lynne Latten
Keyword(s):  
Intensive Care ◽  
Enteral Nutrition ◽  
Nursing Staff ◽  
Enteral Feeding ◽  
Physician Assistants ◽  
Paediatric Intensive Care ◽  
Haemodynamic Instability ◽  
Professional Groups ◽  
Energy Delivery ◽  
The Uk

The aim of the present study was to describe the present knowledge of healthcare professionals and the practices surrounding enteral feeding in the UK and Irish paediatric intensive care unit (PICU) and propose recommendations for practice and research. A cross-sectional (thirty-four item) survey was sent to all PICU listed in the Paediatric Intensive Care Audit Network (PICANET) database (http://www.picanet.org.uk) in November 2010. The overall PICU response rate was 90 % (27/30 PICU; 108 individual responses in total). The overall breakdown of the professional groups was 59 % nursing staff (most were children's nurses), 27 % medical staff, 13 % dietitians and 1 % physician assistants. Most units (96 %) had some written guidance (although brief and generic) on enteral nutrition (EN); 85 % of staff, across all professional groups (P= 0·672), thought that guidelines helped to improve energy delivery in the PICU. Factors contributing to reduced energy delivery included: fluid-restrictive policies (60 %), the child just being ‘too ill’ to feed (17 %), surgical post-operative orders (16 %), nursing staff being too slow in starting feeds (7 %), frequent procedures requiring fasting (7 %) and haemodynamic instability (7 %). What constituted an ‘acceptable’ level of gastric residual volume (GRV) varied markedly across respondents, but GRV featured prominently in the decision to both stop EN and to determine feed tolerance and was similar for all professional groups. There was considerable variation across respondents about which procedures required fasting and the duration of this fasting. The present survey has highlighted the variability of the present enteral feeding practices across the UK and Ireland, particularly with regard to the use of GRV and fasting for procedures. The present study highlights a number of recommendations for both practice and research.

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