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Emergency paediatric critical care in England: describing trends using routine hospital data
  1. Kate Marie Lewis1,
  2. Sanjay M Parekh1,2,
  3. Padmanabhan Ramnarayan3,
  4. Ruth Gilbert1,2,4,
  5. Pia Hardelid1,
  6. Linda Wijlaars1,2
  1. 1 Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
  2. 2 Children and Families Policy Research Unit, UCL Great Ormond Street Institute of Child Health, London, UK
  3. 3 Children's Acute Transport Service, Great Ormond Street Hospital NHS Foundation Trust, London, UK
  4. 4 Health Data Research UK, London, UK
  1. Correspondence to Kate Marie Lewis, Population, Policy and Practice, University College London Institute of Child Health, London WC1N 1EH, UK; kate.lewis.14{at}


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.

  • epidemiology
  • intensive care

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  • Contributors PR, RG PH and LW initiated the project; KML and SMP conducted the statistical analysis and wrote the first draft; all authors critically revised the manuscript and approved the final version.

  • Funding This work was supported by funding from the NIHR through the Great Ormond Street Hospital Biomedical Research Centre, a Senior Investigator award (RG), and the Policy Research Unit in the Health of Children, Young People and Families (grant reference number 109/0001R). KML is supported by a Medical Research Council UK doctoral training studentship (MR/N013867/1). RG receives funding from Health Data Research UK. 2008/09 to 2016/17 paediatric intensive care activity data included in this study have kindly been supplied by the Paediatric Intensive Care Audit Network (PICANet), in collaboration with the Universities of Leeds and Leicester, with support of the PIC community (

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval An approval by an ethics committee was not applicable. The use of Hospital Episodes Statistics data was approved by the Health and Social Care Information Centre for the purpose of this study (DARS-NIC-393510-D6H1D-v1.11).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. This study uses NHS hospital episode statistics data and was provided within the terms of a data sharing agreement (NIC-393510-D6H1D-v3.2) to the researchers by the Health and Social Care Information Centre ('NHS Digital'). The data do not belong to the authors and may not be shared by the authors, except in aggregate form for publication. Data can be obtained by submitting a data request through the NHS Digital Data Access Request Service.