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Intensive care: because we can or because we should?
  1. Gale A Pearson
  1. Department of Paediatric Intensive Care, Birmingham Children’s Hospital, Birmingham, UK
  1. Correspondence to Dr Gale A Pearson, Department of Paediatric Intensive Care, Birmingham Children’s Hospital, Birmingham B4 6NH, UK; gale.pearson{at}bch.nhs.uk

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The case mix of our paediatric intensive care units (PICU) is changing and not by design or commissioned intention. The results are presented of a data linkage between the Paediatric Intensive Care Audit Network (PICANET), Hospital Episode Statistics and the Office for National Statistics.1 By applying a customised coding framework taken from the International Classification of Diseases, the researchers identified that 57.6% of PICU admissions and 72.9% of deaths were for children with a life-limiting condition; proportions that have been increasing over the 11 years studied. This would be consistent with a trend identified in Australian data where over time children who would not have been admitted to intensive care in the past are now routinely offered intensive care.2

The life-limiting conditions defined by the authors are a broad list of diagnoses including congenital heart disease, cancers, genetic/metabolic diseases and others, and the increase in their proportion among intensive care admissions implies that the case mix of admission to UK PICUs is increasing in complexity. This is occurring alongside the already reported increase in prevalence of the same conditions in the population at large.3 The paper goes further in helping to characterise the case mix of modern PICU. Of the 89 000 patients with life-limiting conditions in the study, over 40 000 were admitted as part of a ‘planned’ admission, …

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