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Abstract
Objective To determine the number of individual children admitted to Paediatric Intensive Care Units (PICUs) in England and Wales between 2004 and 2013 and to investigate potential factors for any change over time, including ethnicity.
Methods Anonymised demographic and epidemiological data were extracted from the Paediatric Intensive Care Audit Network (PICANet) database and analysed for all children resident in England and Wales admitted to PICUs of National Health Service (NHS) hospitals in those countries between 2004 and 2013. Population data, including births, were obtained from the Office of National Statistics and analysed. Predicted numbers of children admitted to PICU were compared with actual admissions, averaged over 3-year periods.
Results Increasing numbers of individual children were admitted to PICUs in England and Wales between 2004 and 2013. The largest increases were among younger children (0–5 years) and those with primary respiratory or cardiac diagnoses. They were also greatest in regions with the most mothers born overseas. From 2009 onwards, more children were admitted to PICUs than predicted, separate from overall population growth, South Asian ethnicity or requirement for ventilation.
Conclusions An additional increase in the number of children from England and Wales admitted to PICU from 2009 onwards is not explained by a rising child population or an increased risk of admission among South Asian children. There was no evidence of a reduction in the admission criteria to PICUs. Given healthcare funding in England and Wales, continued increases would present a challenging prospect for both providers and commissioners of these services.
- paediatric intensive care
- population demographics
- admission rates
- co-morbidity
- complexity
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Footnotes
Contributors PJD initially conceived the study and with CJS obtained the initial data from PICANet and the Office of National Statistics, from which a first draft of the manuscript was completed. In discussion between all the authors, further data analyses were performed by AE and ESD on the PICANet data. All authors were involved in the subsequent versions of the manuscript and contributed substantially to its revision and approved its final version.
Funding The PICANet audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme (NCA). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement and, in particular, to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the NCA Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. PICANet is funded by NHS England, Health Commission Wales Specialised Services, NHS Lothian / National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, The National Office of Clinical Audit, Republic of Ireland and HCA Healthcare.
Competing interests None declared.
Patient consent PICANet has MREC ethics committee approval (05/MRE04/17) and National Information Governance Board (4-07(c)/2002-PICANet) approvals to collect patient identifiable data without informed consent.
Ethics approval MREC ethics committee approval (05/MRE04/17)
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data were obtained either from PICANet or from publically available data from the Office of National Statistics. There is a data access request procedure for all analyses relating to PICANet data. This was followed with approval from the PICANet Clinical Advisory Group as per their Terms of Reference. An updated version of the procedure is available on the PICANet website: www.picanet.org.