Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
Arch Dis Child. 2020 Nov;105(11):1061-1067. doi: 10.1136/archdischild-2019-317902. Epub 2020 May 22.
To determine trends in emergency admission rates requiring different levels of critical care in hospitals with and without a paediatric intensive care unit (PICU).
Birth cohort study created from Hospital Episode Statistics.
National Health Service funded hospitals in England.
8 577 680 singleton children born between 1 May 2003 and 31 April 2017.
Using procedure and diagnostic codes, we assigned indicators of high dependency care (eg, non-invasive ventilation) or intensive care (eg, invasive ventilation) to emergency admissions.
Children were followed up until their fifth birthday to estimate high dependency and intensive care admission rates in hospitals with and without a PICU. We tested the yearly trend of high dependency and intensive care admissions to hospitals without a PICU using logistic regression models.
Emergency admissions requiring high dependency care in hospitals without a PICU increased from 3.30 (95% CI 3.09 to 3.51) per 10 000 child-years in 2008/2009 to 7.58 (95% CI 7.28 to 7.89) in 2016/2017 and overtook hospitals with a PICU in 2015/2016. The odds of an admission requiring high dependency care to a hospital without a PICU compared with a hospital with a PICU increased by 9% per study year (OR 1.09, 95% CI 1.08 to 1.10). The same trend was not present for admissions requiring intensive care (OR 1.01, 95% CI 0.99 to 1.03).
Between 2008/2009 and 2016/2017, an increasing proportion of admissions with indicators of high dependency care took place in hospitals without a PICU.
确定在有和没有儿科重症监护病房（PICU）的医院中，需要不同级别重症监护的急诊入院率的趋势。
从医院入院统计数据中创建的出生队列研究。
英格兰的国民保健服务基金会资助的医院。
2003 年 5 月 1 日至 2017 年 4 月 31 日期间出生的 8577680 名单胎儿童。
我们使用程序和诊断代码，将高依赖护理（例如，无创通气）或重症监护（例如，有创通气）的指标分配给急诊入院。
在儿童五岁生日之前对其进行随访，以估计有无 PICU 的医院的高依赖和重症监护入院率。我们使用逻辑回归模型测试了无 PICU 的医院高依赖和重症监护入院的年度趋势。
无 PICU 的医院中需要高依赖护理的急诊入院率从 2008/2009 年的每 10000 儿童年 3.30（95%CI 3.09 至 3.51）增加到 2016/2017 年的 7.58（95%CI 7.28 至 7.89），并在 2015/2016 年超过了有 PICU 的医院。与有 PICU 的医院相比，无 PICU 的医院需要高依赖护理的入院的可能性增加了 9%/年（OR 1.09，95%CI 1.08 至 1.10）。需要重症监护的入院则没有出现同样的趋势（OR 1.01，95%CI 0.99 至 1.03）。
在 2008/2009 年至 2016/2017 年期间，需要高依赖护理指标的入院中，越来越多的发生在没有 PICU 的医院。
