Trends in long-stay admissions to a UK paediatric intensive care unit

Area of Science:

• Pediatric critical care medicine
• Healthcare resource utilization
• Epidemiology of critical illness

Background:

• Prolonged admissions to paediatric intensive care units (PICUs) represent a significant healthcare resource demand.
• While global trends show an increase in long-stay PICU admissions, data from the UK has been limited.
• Understanding these trends is crucial for future paediatric intensive care planning.

Purpose of the Study:

• To analyze trends in long-stay paediatric intensive care unit (PICU) admissions and their associated resource utilization and mortality over a 20-year period in the UK.
• To determine if the proportion of long-stay admissions and bed-days has increased.
• To compare patient demographics, diagnoses, and hospital utilization between long-stay and other PICU admissions.

Main Methods:

• Retrospective analysis of prospectively collected data from a UK paediatric hospital from 1998 to 2017.
• Categorization of admissions into long-stay (≥28 days) and others.
• Analysis of trends in admissions, bed-days, length of stay, and mortality across four epochs.
• Comparison of patient characteristics and resource utilization.

Main Results:

• Long-stay admissions (2.9% of total) accounted for a disproportionate 32% of total bed-days.
• The proportion of long-stay admissions and bed-days significantly increased from 1.6% and 20.5% (1998-2002) to 4.5% and 42.6% (2013-2017).
• Long-stay patients exhibited higher overall hospital admissions, longer hospital stays, and significantly greater crude mortality (23% vs. 6%).

Conclusions:

• A significant increase in prolonged paediatric intensive care unit (PICU) admissions has been observed over two decades.
• These long-stay admissions are associated with disproportionately high resource utilization and mortality.
• The findings underscore the growing impact of prolonged PICU stays on healthcare resources and patient outcomes.