Aim To better understand the care needs of complex children in the PICU environment.
Background The epidemiology of the patients on PICU has changed towards an increase in those with chronic disease and increased morbidity. There are few studies on the specific care needs of these complex children.
Method This was a single centre retrospective observational cohort study with Caldicott approval. Inclusion criteria were: children (0–18 years) admitted to PICU with 2 or more congenital anomalies or long term support in 2 systems (>6 months prior to admission) and a PICU stay of 7 or more days. Data was collected from 08/11/10–08/11/11 sourced from the PICU admission database, medical notes, PICANET and the pharmacy database. Length of stay and mortality was compared to the non-complex group admitted in the same time period (Mann Whitney U and χ2 tests respectively).
Results 593 admissions involved 492 children. 23 Children fulfilled the inclusion criteria. Underlying diagnoses of the complex group varied greatly with congenital anomalies of the GI tract being the most frequent. The complex group accounted for 5.6% of total admissions (33/593). Median length of stay was 14 days (range 4–182) and total bed days was 903. This compared to 2 (range 1–37) and 2074 days respectively in the non-complex group, (p < 0.001). 53% (12/23) had previous PICU admissions and 17% (4/23) were admitted from birth. At discharge 91% (21/23) had 2 or more sub-specialities involved in their care.
There was a trend towards higher hospital mortality–17.4% (4/23) compared with 5.5% (26/469) in the non-complex group-odds ratio 3.59 (95% confidence interval 1.1 to 11.3) (p = 0.02)
Conclusion Complex patients made up 5.6% of PICU admissions but reflected 30% of bed days/year. They required high levels of intervention and sub-speciality involvement. A regular pro-active discussion forum might optimise care and effectively address the specific care needs of this group.