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

Arch Dis Child. 2020 Nov;105(11):1061-1067. doi: 10.1136/archdischild-2019-317902. Epub 2020 May 22.


Objective: To determine trends in emergency admission rates requiring different levels of critical care in hospitals with and without a paediatric intensive care unit (PICU).

Design: Birth cohort study created from Hospital Episode Statistics.

Setting: National Health Service funded hospitals in England.

Patients: 8 577 680 singleton children born between 1 May 2003 and 31 April 2017.

Outcome measures: Using procedure and diagnostic codes, we assigned indicators of high dependency care (eg, non-invasive ventilation) or intensive care (eg, invasive ventilation) to emergency admissions.

Interventions: Children were followed up until their fifth birthday to estimate high dependency and intensive care admission rates in hospitals with and without a PICU. We tested the yearly trend of high dependency and intensive care admissions to hospitals without a PICU using logistic regression models.

Results: Emergency admissions requiring high dependency care in hospitals without a PICU increased from 3.30 (95% CI 3.09 to 3.51) per 10 000 child-years in 2008/2009 to 7.58 (95% CI 7.28 to 7.89) in 2016/2017 and overtook hospitals with a PICU in 2015/2016. The odds of an admission requiring high dependency care to a hospital without a PICU compared with a hospital with a PICU increased by 9% per study year (OR 1.09, 95% CI 1.08 to 1.10). The same trend was not present for admissions requiring intensive care (OR 1.01, 95% CI 0.99 to 1.03).

Conclusions: Between 2008/2009 and 2016/2017, an increasing proportion of admissions with indicators of high dependency care took place in hospitals without a PICU.

Keywords: epidemiology; intensive care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Child, Preschool
  • Critical Care / statistics & numerical data*
  • Critical Illness / epidemiology
  • Emergency Medical Services / statistics & numerical data*
  • England / epidemiology
  • Female
  • Hospitals / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units / statistics & numerical data
  • Intensive Care Units, Pediatric / statistics & numerical data
  • Logistic Models
  • Male