Portal de Periódicos da CAPES

Should paediatric intensive care be centralised?

1997; Elsevier BV; Volume: 350; Issue: 9070 Linguagem: Inglês

10.1016/s0140-6736(97)26027-7

1474-547X

Bruce Maybloom, Jean Chapple, Leslie L. Davidson, Caroline Mawer,

Respiratory Support and Mechanisms

The study by Gale Pearson and colleagues (April 26, p 1213),1Pearson G Shann F Barry P et al.Should paediatric intensive care be centralised? Trent versus Victoria.Lancet. 1997; 349: 1213-1217Summary Full Text Full Text PDF PubMed Scopus (196) Google Scholar comparing the Trent region, UK, with the Australian State of Victoria, supports centralisation of paediatric intensive care. Our study in the Thames regions in south-east England aims to identify all children aged 0–16 who have an acute critical illness, rather than just those admitted to intensive-care units (ICUs). Besides ten paediatric ICUs, four paediatric cardiothoracic units, and 68 adult ICUs, the survey covers all children's wards, emergency, and specialist units in the North and South Thames regions.Children with critical illness were defined on specific organ-failure criteria adapted from the Advanced Paediatric Life-Support Guidelines.1Pearson G Shann F Barry P et al.Should paediatric intensive care be centralised? Trent versus Victoria.Lancet. 1997; 349: 1213-1217Summary Full Text Full Text PDF PubMed Scopus (196) Google Scholar We have not attempted to look in detail at severity of illness. Preliminary data, from Nov 1, 1996, to March 31, 1997, show that paediatric ICUs admitted 987 children for 1093 episodes, adult ICUs admitted 180 children for 187 episodes, children's wards admitted 517 children for 544 episodes, and the paediatric cardiothoracic units admitted 459 children for 462 episodes of critical care.The Trent/Victoria study disregards important issues. North and South Thames are well provided with paediatric ICUs but many episodes of critical illness were not managed in an ICU at all; 49·6% (270) of the children's ward episodes that met the definition of critical illness were not in an ICU at any time. This fact has to be considered in any plans for centralising paediatric intensive care.The Trent/Victoria study provides limited information on service provision, staffing ratios, and case mix. We suspect that the provision of intensive care in Trent differs from that in the Thames regions, and we have reservations about extrapolating from Trent to the UK, as R J B J Gemke does in a commentary on this paper.3Gemke R Centralisation of paediatric intensive care to improve outcome.Lancet. 1997; 349: 1187-1188Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar While we do support the logic of centralising paediatric intensive care in larger units, our study shows that critical illness in children is a much wider issue than the percentage of children in ICUs.We thank health-care providers in the North and South Thames regions for their participants. The study by Gale Pearson and colleagues (April 26, p 1213),1Pearson G Shann F Barry P et al.Should paediatric intensive care be centralised? Trent versus Victoria.Lancet. 1997; 349: 1213-1217Summary Full Text Full Text PDF PubMed Scopus (196) Google Scholar comparing the Trent region, UK, with the Australian State of Victoria, supports centralisation of paediatric intensive care. Our study in the Thames regions in south-east England aims to identify all children aged 0–16 who have an acute critical illness, rather than just those admitted to intensive-care units (ICUs). Besides ten paediatric ICUs, four paediatric cardiothoracic units, and 68 adult ICUs, the survey covers all children's wards, emergency, and specialist units in the North and South Thames regions. Children with critical illness were defined on specific organ-failure criteria adapted from the Advanced Paediatric Life-Support Guidelines.1Pearson G Shann F Barry P et al.Should paediatric intensive care be centralised? Trent versus Victoria.Lancet. 1997; 349: 1213-1217Summary Full Text Full Text PDF PubMed Scopus (196) Google Scholar We have not attempted to look in detail at severity of illness. Preliminary data, from Nov 1, 1996, to March 31, 1997, show that paediatric ICUs admitted 987 children for 1093 episodes, adult ICUs admitted 180 children for 187 episodes, children's wards admitted 517 children for 544 episodes, and the paediatric cardiothoracic units admitted 459 children for 462 episodes of critical care. The Trent/Victoria study disregards important issues. North and South Thames are well provided with paediatric ICUs but many episodes of critical illness were not managed in an ICU at all; 49·6% (270) of the children's ward episodes that met the definition of critical illness were not in an ICU at any time. This fact has to be considered in any plans for centralising paediatric intensive care. The Trent/Victoria study provides limited information on service provision, staffing ratios, and case mix. We suspect that the provision of intensive care in Trent differs from that in the Thames regions, and we have reservations about extrapolating from Trent to the UK, as R J B J Gemke does in a commentary on this paper.3Gemke R Centralisation of paediatric intensive care to improve outcome.Lancet. 1997; 349: 1187-1188Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar While we do support the logic of centralising paediatric intensive care in larger units, our study shows that critical illness in children is a much wider issue than the percentage of children in ICUs. We thank health-care providers in the North and South Thames regions for their participants. DEPARTMENT OF ERRORShould paediatric intensive care be centralised?—In this correspondence letter by Robert C Tasker (July 5, 1997, p 66), the heading for the figure on the right should read Normal; the heading for the figure on the left should read Acidotic. Full-Text PDF Should paediatric intensive care be centralised?Authors' reply Full-Text PDF