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Trends in long-stay admissions to a UK paediatric intensive care unit
  1. Hari Krishnan Kanthimathinathan1,2,
  2. Adrian Plunkett1,
  3. Barnaby R Scholefield1,3,
  4. Gale A Pearson1,
  5. Kevin P Morris1,4
  1. 1Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  2. 2Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
  3. 3Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  4. 4Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Hari Krishnan Kanthimathinathan, PICU, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK; hari.krishnan2{at}nhs.net

Abstract

Objective Prolonged admission to a paediatric intensive care unit (PICU) consumes significant healthcare resource. An increase in the number of long-stay admissions and bed utilisation has been reported elsewhere in the world but not in the UK. If an increasing trend of long-stay admissions is evident, this may have significant implications for provision of paediatric intensive care in the future.

Design/setting/patients We retrospectively analysed prospectively collected data from Birmingham Children’s Hospital, UK, over a 20-year period from 1998 to 2017. PICU admissions, bed-days, length of stay and mortality trends were analysed and reported over four different epochs (1998–2002, 2003–2007, 2008–2012 and 2013–2017) for long-stay admissions (PICU length of stay ≥28 days) and others. Differences in patient demographics, diagnostic categorisation and hospital utilisation were also analysed.

Results In total, 24 203 admissions accounted for 131 553 bed-days over the 20-year period. 705 (2.9%) long-stay admissions accounted for 42 312 (32%) bed-days. Proportion of long-stay admissions and corresponding bed-days increased from 1.6% and 20.5% in 1998–2002 to 4.5% and 42.6%, respectively, in 2013–2017 (p<0.001). Long-stay patients had a significantly higher number of hospital admissions (median: 4 vs 2, p<0.001) per patient and overall hospital length of stay (median: 98 vs 15, p<0.001) bed-days compared with other patients. Long-stay admissions were associated with significantly higher crude mortality (23% vs 6%, p<0.001) compared with other admissions.

Conclusions A significant increase in the proportion of prolonged PICU admissions with disproportionately high resource utilisation and mortality is evident over two decades.

  • intensive care
  • paediatric practice
  • capacity
  • length of stay
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Footnotes

  • Twitter @harrykchris, @adrianplunkett

  • Contributors HKK and KPM conceptualised and designed the study. HKK drafted the initial manuscript, performed data analyses. GAP set up the database and provided data for analysis. AP, BRS, GAP reviewed data analyses and revised the manuscript. All authors approved the final manuscript as submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available.

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