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Paediatric intensive care in a district general hospital
Insights
Critically ill children in adult intensive care units (ICUs) had acceptable mortality outcomes. This study suggests adult ICUs can safely provide pediatric intensive care, challenging prior UK recommendations.
Area of Science:
- Pediatric critical care medicine
- Hospital administration and policy
Background:
- A 1997 UK report recommended against adult intensive care units (ICUs) caring for critically ill children.
- This recommendation lacked supporting outcome data from the UK.
Purpose of the Study:
- To report outcome data from a district general hospital's adult ICU providing pediatric intensive care.
- To evaluate the safety and efficacy of adult ICUs in managing critically ill children.
Main Methods:
- Prospective study over four years.
- Utilized Pediatric Risk of Mortality (PRISM) scoring for 95 children in an adult ICU.
- Compared predicted mortality with observed mortality.
Main Results:
- Observed mortality was 2 deaths.
- Predicted mortality was 2.32 deaths.
- Outcomes were comparable to predicted risk, suggesting acceptable mortality.
Conclusions:
- Adult intensive care units can provide pediatric intensive care services with acceptable mortality rates.
- The findings challenge the 1997 recommendation and suggest further consideration of adult units' role in pediatric critical care.
Abstract:
The report of the 'National Coordinating Group on Paediatric Intensive Care' (NHS Executive 1997) recommended that general (adult) intensive care units in district general hospitals should no longer continue to care for critically ill children apart from providing resuscitation prior to transfer to a specialist centre. This recommendation was made despite a lack of outcome data in the UK to support this conclusion. We wish to report our outcome data from one such unit. Over a four-year period, we have prospectively used Paediatric Risk of Mortality scoring to estimate the risk of death for 95 children cared for in our adult unit in a district general hospital (DGH) and have compared this with the observed outcome. The observed mortality of 2 deaths was less than the predicted mortality of 2.32 deaths. Our results suggest that an adult unit can provide a paediatric intensive care service that is associated with an acceptable outcome in terms of mortality. These data suggest that the role of such units with regard to the provision of paediatric intensive care should be considered further.