Emergency paediatric critical care in England: describing trends using routine hospital data

Area of Science:

• Pediatric critical care medicine
• Health services research
• Epidemiology

Background:

• Paediatric intensive care units (PICUs) provide specialized critical care for critically ill children.
• Understanding trends in emergency admission rates to hospitals with and without PICUs is crucial for resource allocation and care quality.
• Previous research has not fully elucidated the evolving patterns of critical care admissions across different hospital types.

Purpose of the Study:

• To determine trends in emergency admission rates requiring different levels of critical care in hospitals with and without a paediatric intensive care unit (PICU).
• To analyze the shift in high dependency and intensive care admissions between hospitals with and without PICUs over time.

Main Methods:

• Birth cohort study utilizing English Hospital Episode Statistics (HES) data.
• Inclusion of 8,577,680 singleton children born between May 2003 and April 2017.
• Assignment of high dependency or intensive care indicators based on procedure and diagnostic codes for emergency admissions.

Main Results:

• Emergency admissions requiring high dependency care in hospitals without a PICU increased significantly from 3.30 to 7.58 per 10,000 child-years between 2008/2009 and 2016/2017.
• These admissions overtook those in hospitals with a PICU in 2015/2016, with a 9% annual increase in odds.
• No significant trend was observed for admissions requiring intensive care in hospitals without a PICU compared to those with a PICU.

Conclusions:

• An increasing proportion of emergency admissions with indicators of high dependency care occurred in hospitals without a PICU between 2008/2009 and 2016/2017.
• This suggests a growing capacity or utilization of high dependency care in non-PICU settings.
• Further investigation is needed to understand the implications for patient outcomes and healthcare system planning.