Child admissions to intensive care rise 15% in England since 2009BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4954 (Published 27 October 2017) Cite this as: BMJ 2017;359:j4954
The number of children admitted to intensive care in England has risen sharply since 2009, placing additional strain on the NHS, a study has found.1 The authors said that the rise was not explained by an increasing child population or by any change in admission criteria to paediatric intensive care units.
The researchers analysed data from the Paediatric Intensive Care Audit Network on children aged 15 and under from 2004 to 2013. They also analysed population data from the Office for National Statistics to compare the predicted numbers of children admitted to intensive care with the actual admission figures over three year periods.
The number of children admitted to intensive care in England increased by 14.7% over the 10 year study period, while in Wales the increase was 2.2%, the team reported in the Archives of Diseases in Childhood.1 The largest increases were among children under 5 and in those with primary respiratory or cardiac diagnoses.
Children of South Asian ethnicity were more likely to be admitted to paediatric intensive care during a calendar year at any age than those of other ethnicities. Among children of South Asian ethnicity, average admission rates were 75% higher among infants, 107% higher in children aged 1-5, and 93% higher in 6-15 year olds (per 1000 of the population).
In addition, the numbers of children needing assisted ventilation rose considerably over the study period, so this trend cannot be attributed to a lowered admission threshold for intensive care.
The researchers said that migration may be a factor. The largest increases in individual children admitted to intensive care units occurred in the English regions that had the most live births to mothers of eastern European origin. The largest rises were seen in the West Midlands (22.5%), East of England (22.7%), London (30.8%), South East Coast (11.9%), and South Central (43.2%) regions, while other regions showed little or no change.
The period since 2009 also coincided with the start of tighter NHS finances, the researchers said. From 2004 to 2009 UK public healthcare spending increased by 8.3% a year, whereas from 2009 onwards it grew at just 1.9% a year.
Whatever the reason behind this, the researchers concluded, “Increasing numbers of critically ill children requiring paediatric intensive care in England and Wales, including greater numbers of children with complex comorbidities and prolonged lengths of stay, will prove challenging both for paediatric intensive care services and commissioners, as increased demand potentially outstrips resource.”