Objective In 2005 plans were announced to build a new Children’s Hospital in Glasgow, UK. The present completion date is 2012 and work is underway to collect service data to inform the design process. We analysed the presentation and management of children admitted directly to PICU/HDU from the Emergency Department (ED) of a tertiary Children’s Hospital.

Methods Patients admitted to PICU/HDU from the ED between January 2006 and July 2007 were identified retrospectively using the MVICU database.

Results 77 patients were identified, 58% were male and 42% female. 42% were <1 yrs, 38% were 1–5 yrs and 20% were 5–15 yrs. 75% of children ‘self presented’ to the ED with 19% referred by GPs. 5% were referred from other hospitals for medical admission, but subsequently required admission to PICU/HDU. Only 49% of patients arrived by ambulance. The majority of children, 43%, presented with respiratory problems. 21% had severe sepsis and 10% were admitted following seizures. 8% had trauma. 49 children were admitted to PICU, with 35% requiring intubation and 12% inotropic support in the ED. The median time spent in the ED was 113 minutes. The median stay on PICU was 3 days and on HDU 1 day.

Conclusion Half of the children admitted to PICU/HDU were transported to hospital by their family. The majority had not been seen by another medical professional. Sick children present to the ED often with little warning and no pre-hospital care. Plans for the new Children’s Hospital must reflect this.