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Admissions for critically ill children: where and why?
B Maybloom1, J Chapple, L L Davidson
1Directorate of Public Health, Kensington & Chelsea and Westminster Health Authority, London, UK. bru-cepm@hotmail.com
Intensive & Critical Care Nursing
|October 31, 2002
Summary
Many critically ill children receive care outside of pediatric intensive care units (PICUs). This study highlights the need to monitor all critical care settings for children to effectively plan services.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Epidemiology
Background:
- Effective planning for critically ill children requires understanding overall critical care activity and population needs.
- A prospective needs assessment was conducted to estimate population-based admission rates for pediatric critical care.
Purpose of the Study:
- To estimate population-based admission rates for pediatric critical care.
- To assess the variation in critical care admission rates across different care settings.
- To inform the planning of regional critical care services for children.
Main Methods:
- A census approach was used, collecting data via survey forms for all admissions of children under 17 in south-east England.
- Critical illness was defined by clinical criteria indicating acute body-system or multi-system failure.
- Tracheal intubation served as a proxy for the need for intensive care.
Main Results:
- Admission rates varied widely, from 1.2 per 1000 children for PIC units to 0.02 per 1000 for neonatal units.
- 52% of intubated children in neurosurgical units and 41% in adult ICUs were not transferred to PICUs.
- Age and admission rates correlated with the type of care setting.
Conclusions:
- A significant number of critically ill children receive care outside of dedicated PIC units.
- Monitoring critical care activity in all locations is crucial for national policy changes and service planning.
- Findings emphasize the need to measure service use across all critical care settings, not just PICUs, and to establish clear criteria for high dependency units.