Characteristics and outcome of children admitted to adult intensive care units in England, Wales and Northern Ireland (1996-2011)

摘要

Purpose: Despite centralisation of paediatric intensive care units (PICU) in the UK, children continue to be admitted to adult intensive care units (AICU). We aimed to analyse trends in the admission of children to AICUs over a 16-year period from 1996, and describe their case mix, outcome and resource use in a recent cohort (2009-2011). Methods: We extracted data from consecutive admissions of children (1996-2011) to AICUs from the Intensive Care National Audit and Research Centre Case Mix Programme Database. We studied case mix, outcome and resource use as well as regional, seasonal and temporal variations in admissions of children to AICU. Results: A total of 13,430 children were admitted to AICUs between 1996 and 2011 (representing 1.3 % of all admissions). This proportion decreased from 2.8 % in 1996 to 0.6 % in 2011. Crude mortality fell from 6.7 to 2.8 %, and the proportion transferred out to a PICU rose from 18.9 to 51.4 %. In recent years (2009-2011), half of the 2,320 admissions of children occurred in just three English Strategic Health Authorities. The median length of unit stay was 7.7 h (IQR 3.8-19.7) for survivors and 11.5 h (IQR 5.0-36.2) for non-survivors. Conclusions: The number of children admitted to AICUs in England, Wales and Northern Ireland has been steadily declining since 1996. In recent years, half of all children admitted to AICUs are transferred to PICU, usually following a short stay. The reasons for regional variation in paediatric admissions to AICUs, and the cause of death in the small number of children who die in AICUs, are unclear.