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Paediatric admissions to the general intensive care unit at palmerston north hospital
1Department of Anaesthesia and Intensive Care, Palmerston North Hospital, Palmerston North, New Zealand gerardm@midcentral.co.nz.
Insights
Palmerston North Hospital
Area of Science:
- Pediatric Intensive Care
- Hospital Management
- Healthcare Regionalization
Background:
- Non-tertiary hospitals manage a significant number of critically ill pediatric patients.
- Understanding the characteristics of these admissions is crucial for service planning.
Purpose of the Study:
- To analyze pediatric admissions to Palmerston North Hospital's Intensive Care Unit (ICU).
- To evaluate the feasibility of regionalizing pediatric intensive care services.
Main Methods:
- Retrospective review of ICU database and admission records (1996-1998).
- Clinical and demographic profiling of pediatric patients (<15 years).
- Mortality prediction using the Pediatric Index of Mortality (PIM).
Main Results:
- 76 pediatric admissions (7.4% of total ICU admissions).
- 64% male, 79% required mechanical ventilation; median ICU stay 21.5 hours.
- 3 ICU deaths and 1 post-discharge death vs. 6.37 predicted; 20% transferred to tertiary services.
Conclusions:
- Non-tertiary ICUs manage diverse pediatric critical care cases.
- Local management is often sufficient, but timely transfer is key for integrated care.
- Findings support regionalization of pediatric intensive care.
Objectives:
To report Palmerston North Hospital's (PNH) recent experiences with paediatric admissions to the general Intensive Care Unit (ICU), and to identify any aspects relevant to regionalisation of paediatric intensive care.
Methods:
Retrospective review of the ICU database and admission register to enable clinical and demographic profiling of all paediatric (aged < 15 years) admissions to PNH ICU from 1996 to 1998. Observed and predicted mortalities were compared using the Paediatric Index of Mortality (PIM).
Results:
Seventy-five paediatric patients had 76 admissions, comprising 7.4% of ICU admissions during the study period. Forty-eight (64%) were male, and 59 (79%) of the patients received mechanical ventilatory support. The median ICU stay was 21.5 hours (range 0.1 to 568 hours). There were 3 deaths in the ICU, and one following ICU discharge but prior to hospital discharge, compared with 6.37 predicted deaths. The median PIM score overall was 5.3% predicted probability of death (range 0.8 - 61.4%), with 6 patients (7.9%) having a PIM score of greater than 30%. Fifteen patients (20%) were transferred to tertiary services.
Conclusions:
If the PNH experience reflects that of other similar institutions, then non-tertiary ICUs admit small numbers of critically ill paediatric patients who tend to be of low to moderate severity, but who cover the full spectrum of severity. Most cases can be well managed locally, but appropriate referral and transfer is an important component in the delivery of a rational and integrated paediatric intensive care service.
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