Electronic supplementary material for ICME-D-13-00314
Table 1: Actual and extrapolated numbers of children admitted to adult intensive care units in England, Wales and Northern Ireland from 1996 to 2011
Year / Units submitting data on at least one child admission (all units submitting data to the CMPD) / Total number of admissions of children reported to the CMPD (% of all admissions) / Extrapolated number of admissions of children1996 / 46 (60) / 403 (2.8) / 2,350
1997 / 62 (76) / 697 (2.7) / 2,370
1998 / 80 (94) / 906 (2.7) / 2,440
1999 / 81 (103) / 1,037 (2.7) / 2,510
2000 / 87 (112) / 920 (2.3) / 2,096
2001 / 98 (128) / 910 (1.9) / 1,885
2002 / 106 (147) / 947 (1.6) / 1,607
2003 / 113 (160) / 1,071 (1.5) / 1,657
2004 / 115 (159) / 864 (1.2) / 1,302
2005 / 112 (158) / 892 (1.2) / 1,368
2006 / 110 (159) / 834 (1.1) / 1,270
2007 / 102 (170) / 859 (1.0) / 1,296
2008 / 111 (178) / 770 (0.8) / 1,086
2009 / 114 (185) / 725 (0.7) / 975
2010 / 110 (198) / 815 (0.7) / 993
2011 / 111 (203) / 780 (0.6) / 922
Total / 13,430 (1.3) / 26,127
CMPD: Case Mix Programme Database
Table 2: Year-wise trends in case mix in children admitted to adult intensive care units in England, Wales and Northern Ireland (1996-2011)
1996(n=403) / 1997
(n=697) / 1998
(n=906) / 1999
(n=1037) / 2000
(n=920) / 2001
(n=910) / 2002
(n=947) / 2003
(n=1071) / 2004
(n=864) / 2005
(n=892) / 2006
(n=834) / 2007
(n=859) / 2008
(n=770) / 2009
(n=725) / 2010
(n=815) / 2011
(n=780) / Total
(n=13430)
Age group, n (%)
<1 year / 58 (14.4) / 120 (17.2) / 156 (17.2) / 151 (14.6) / 156 (17.0) / 137 (15.1) / 135 (14.2) / 154 (14.4) / 147 (17.0) / 155 (17.4) / 115 (13.8) / 160 (18.6) / 124 (16.1) / 112 (15.5) / 192 (23.6) / 165 (21.2) / 2237 (16.7)
1-4 years / 121 (30.0) / 175 (25.1) / 250 (27.6) / 289 (27.9) / 243 (26.4) / 215 (23.6) / 196 (20.7) / 289 (27.0) / 192 (22.2) / 213 (23.9) / 192 (23.0) / 225 (26.2) / 213 (27.7) / 206 (28.4) / 212 (26.0) / 199 (25.5) / 3430 (25.5)
5-10 years / 109 (27.1) / 152 (21.8) / 184 (20.3) / 229 (22.1) / 172 (18.7) / 184 (20.2) / 192 (20.3) / 186 (17.4) / 184 (21.3) / 152 (17.0) / 131 (15.7) / 157 (18.3) / 127 (16.5) / 133 (18.3) / 114 (14.0) / 114 (14.6) / 2520 (18.8)
11-15 years / 115 (28.5) / 250 (35.9) / 316 (34.9) / 368 (35.5) / 349 (37.9) / 374 (41.1) / 424 (44.8) / 442 (41.3) / 341 (39.5) / 372 (41.7) / 396 (47.5) / 317 (36.9) / 306 (39.7) / 274 (37.8) / 297 (36.4) / 302 (38.7) / 5243 (39.0)
Source of admission, n (%)
Same hospital / 364 (90.3) / 657 (94.3) / 855 (94.4) / 981 (94.7) / 880 (95.7) / 879 (96.6) / 921 (97.3) / 1051 (98.1) / 845 (97.8) / 878 (98.4) / 808 (96.9) / 843 (98.1) / 745 (96.8) / 712 (98.3) / 797 (97.8) / 769 (98.6) / 12985 (96.7)
Other hospital / 39 (9.7) / 38 (5.4) / 47 (5.2) / 51 (4.9) / 39 (4.2) / 30 (3.3) / 25 (2.6) / 17 (1.6) / 17 (2.0) / 14 (1.6) / 26 (3.1) / 14 (1.6) / 24 (3.1) / 11 (1.5) / 15 (1.8) / 11 (1.4) / 418 (3.1)
Clinic/home/other / 0 (0.0) / 2 (0.3) / 4 (0.4) / 5 (0.4) / 1 (0.1) / 1 (0.1) / 1 (0.1) / 3 (0.3) / 2 (0.2) / 0 (0.0) / 0 (0.0) / 2 (0.2) / 1 (0.1) / 2 (0.2) / 3 (0.4) / 0 (0.0) / 25 (0.2)
Location prior to admission, n (%)*
Emergency department / 99 (27.2) / 182 (27.6) / 260 (30.4) / 341 (34.8) / 326 (37.1) / 354 (40.3) / 361 (39.2) / 442 (42.1) / 386 (45.7) / 354 (40.3) / 324 (40.10) / 336 (39.9) / 342 (45.9) / 308 (43.3) / 339 (42.5) / 302 (39.3) / 5056 (38.9)
Ward / 114 (31.3) / 206 (31.4) / 260 (30.4) / 290 (29.6) / 266 (30.2) / 239 (27.2) / 259 (28.10) / 290 (27.6) / 220 (26.0) / 255 (29.0) / 237 (29.3) / 278 (33.0) / 226 (30.3) / 227 (31.9) / 260 (32.6) / 257 (33.4) / 3884 (29.9)
Theatres/recovery / 114 (31.3) / 181 (27.6) / 230 (26.9) / 240 (24.4) / 189 (21.5) / 176 (20.0) / 185 (20.1) / 187 (17.8) / 136 (16.1) / 137 (15.6) / 160 (19.8) / 132 (15.6) / 93 (12.5) / 97 (13.6) / 98 (12.3) / 136 (17.7) / 2491 (19.2)
Other / 37 (10.2) / 88 (13.4) / 105 (12.3) / 110 (11.2) / 99 (11.2) / 110 (12.5) / 116 (12.6) / 132 (12.5) / 103 (12.2) / 132 (15.0) / 87 (10.8) / 97 (11.5) / 84 (11.3) / 80 (11.2) / 100 (12.6) / 74
(9.6) / 1554 (12.0)
Surgical status, n (%)
Non-surgical / 288 (71.5) / 514 (73.7) / 676 (74.6) / 795 (76.7) / 730 (79.4) / 734 (80.7) / 760 (80.3) / 883 (82.5) / 727 (84.1) / 752 (84.3) / 674 (80.8) / 723 (84.2) / 673 (87.4) / 624 (86.1) / 716 (87.9) / 643 (82.5) / 10912 (81.2)
Elective surgery / 68 (16.8) / 99 (14.2) / 125 (13.8) / 127 (12.2) / 95 (10.3) / 87 (9.6) / 78 (80.2) / 74 (6.9) / 47 (5.4) / 46 (5.2) / 71 (8.5) / 48 (5.6) / 42 (5.5) / 31 (4.3) / 31 (3.8) / 72 (9.2) / 1141 (8.5)
Emergency surgery / 45 (11.2) / 84 (12.1) / 105 (11.6) / 112 (10.8) / 93 (10.1) / 89 (9.8) / 109 (11.5) / 114 (10.6) / 90 (10.4) / 94 (10.5) / 89 (10.7) / 88 (10.2) / 55 (7.1) / 70 (9.7) / 68 (8.3) / 64 (8.2) / 1369 (10.2)
Data missing / 2 (0.5) / 0 (0.0) / 0 (0.0) / 3 (0.3) / 2 (0.2) / 0 (0.0) / 0 (0.0) / 0 (0.00) / 0 (0.0) / 0 (0.0) / 0 (0.0) / 0 (0.0) / 0 (0.0) / 0 (0.0) / 0 (0.0) / 1 (0.1) / 8 (0.1)
Admission type, n (%)
Trauma / 84 (20.8) / 128 (18.4) / 163 (18.0) / 212 (20.4) / 161 (17.5) / 164 (18.0) / 193 (20.4) / 151 (14.1) / 140 (16.2) / 144 (16.1) / 142 (17.0) / 108 (12.6) / 104 (13.5) / 83 (11.4) / 79 (9.7) / 68 (8.7) / 2124 (15.8)
Non-trauma / 317 (78.7) / 566 (81.2) / 735 (81.1) / 817 (78.8) / 754 (82.0) / 745 (81.9) / 750 (79.2) / 912 (85.2) / 723 (83.7) / 745 (83.5) / 690 (82.7) / 744 (86.6) / 665 (86.4) / 642 (88.6) / 735 (90.2) / 712 (91.3) / 11252 (83.8)
Data missing / 2 (0.5) / 3 (0.4) / 8 (0.9) / 8 (0.8) / 5 (0.5) / 1 (0.1) / 4 (0.4) / 8 (0.7) / 1 (0.1) / 3 (0.3) / 2 (0.2) / 7 (0.8) / 1 (0.1) / 0 (0.0) / 1 (0.1) / 0 (0.0) / 54 (0.4)
ICNARC Physiology Score, median (IQR) / 17 (11-25) / 16 (10-23) / 16 (10-23) / 16 (11-24) / 17 (12-24) / 16 (11-23) / 16 (11-22) / 16 (11-23) / 17 (11-23) / 16 (11-24) / 17 (11-23) / 17 (11-25) / 16 (10-23) / 17 (11-24) / 17 (11-24) / 17 (11-24) / 17 (11-24)
Modified PRISM score, median (IQR) / 7 (3-13) / 6 (4-12) / 6 (4-12) / 6 (4-12) / 7 (4-12) / 6 (4-12) / 6 (4-12) / 6 (3-11) / 7 (4-12) / 6 (4-11) / 6 (3-12) / 6 (2-10) / 4 (2-8) / 5 (3-9) / 5 (2-9) / 5 (2-8) / 6 (3-11)
*Only admissions from Same Hospital (n=12,985) included in the breakdown of Location prior to admission; IQR: inter-quartile range
Table 3: Reasons for admission of children to adult intensive care units in England, Wales and Northern Ireland (2009-2011)
<1 yr(N=469) / 1-4 yrs
(N=617) / 5-10 yrs
(N=361) / 11-15 yrs
(N=873) / Total
(N=2,320)
Status epilepticus or uncontrolled seizures / 51 (10.9) / 179 (29.0) / 91 (25.2) / 78 (8.9) / 399 (17.2)
Pneumonia (various etiologies) / 103 (22.0) / 98 (15.9) / 54 (15.0) / 79 (9.0) / 334 (14.4)
Bronchiolitis / 135 (28.8) / 17 (2.8) / 0 (0.0) / 0 (0.0) / 152 (6.6)
Upper airway obstruction (various etiologies) / 45 (9.6) / 66 (10.7) / 23 (6.4) / 19 (2.2) / 153 (6.6)
Asthma attack in new or known asthmatic / 2 (0.4) / 57 (9.2) / 37 (10.2) / 42 (4.8) / 138 (5.9)
Traumatic head injury / 17 (3.6) / 28 (4.5) / 22 (6.1) / 71 (8.1) / 138 (5.9)
Poisoning / 3 (0.6) / 13 (2.1) / 3 (0.8) / 118 (13.5) / 137 (5.9)
Other trauma / 4 (0.9) / 15 (2.4) / 19 (5.3) / 88 (10.1) / 126 (5.4)
Meningitis (various etiologies) / 28 (6.0) / 42 (6.8) / 11 (3.0) / 21 (2.4) / 102 (4.4)
Abdominal surgical / 4 (0.9) / 5 (0.8) / 24 (6.6) / 61 (7.0) / 94 (4.1)
Diabetic ketoacidosis / 0 (0.0) / 4 (0.6) / 6 (1.7) / 52 (6.0) / 62 (2.7)
Kyphoscoliosis / 0 (0.0) / 1 (0.2) / 4 (1.1) / 48 (5.5) / 53 (2.3)
Sepsis and shock / 13 (2.8) / 11 (1.8) / 15 (4.2) / 14 (1.6) / 53 (2.3)
Haematological/Oncological disorder / 1 (0.2) / 5 (0.8) / 4 (1.1) / 22 (2.5) / 32 (1.4)
Coma or encephalopathy (various etiologies) / 7 (1.5) / 4 (0.6) / 5 (1.4) / 14 (1.6) / 30 (1.3)
Acquired heart disease / 5 (1.1) / 4 (0.6) / 0 (0.0) / 9 (1.0) / 18 (0.8)
Congenital heart disease / 15 (3.2) / 2 (0.3) / 0 (0.0) / 0 (0.0) / 17 (0.7)
Other / 36 (7.7) / 66 (10.7) / 43 (11.9) / 137 (15.7) / 282 (12.2)
Table 4: Regional variation in unit discharge outcome and length of stay on the adult intensive care unit for children transferred out to a paediatric intensive care unit, 2009-2011 (n=2320)
Died, n (%) / Discharged alive (non-PICU), n (%) / Transferred to PICU, n (%) / Transferred to PICU (n=1115)LOS6 h, n (%) / LOS >6 h, n (%)
England
East Midlands / 4 (6.0) / 29 (43.3) / 34 (50.7) / 28 (82.4) / 6 (17.6)
East of England / 8 (2.4) / 147 (44.8) / 173 (52.7) / 112 (64.7) / 61 (35.3)
London / 3 (4.6) / 52 (80.0) / 10 (15.4) / 5 (50.0) / 5 (50.0)
North East / 1 (1.5) / 57 (83.8) / 10 (14.7) / 9 (90.0) / 1 (10.0)
North West / 5 (4.7) / 43 (40.2) / 59 (55.1) / 44 (74.6) / 15 (25.4)
South Central / 2 (1.1) / 107 (58.5) / 74 (40.4) / 48 (64.9) / 26 (35.1)
South East Coast / 2 (1.0) / 59 (28.6) / 145 (70.4) / 129 (89.0) / 16 (11.0)
South West / 20 (3.4) / 283 (48.1) / 285 (48.5) / 176 (61.8) / 109 (38.2)
West Midlands / 2 (1.4) / 64 (45.4) / 75 (53.2) / 61 (81.3) / 14 (18.7)
Yorkshire and The Humber / 12 (4.8) / 125 (49.8) / 114 (45.4) / 82 (71.9) / 32 (28.1)
Wales / 2 (1.0) / 78 (38.0) / 125 (61.0) / 108 (86.4) / 17 (13.6)
Northern Ireland / 4 (3.6) / 96 (86.5) / 11 (9.9) / 11 (100.0) / 0 (0.0)
PICU: paediatric intensive care unit; LOS: length of stay
Table 5: Age-sex standardised prevalence (per 100,000 per year) for admissions of children aged <16 years to adult intensive care units in England and Wales, 2009-2011 (n=1205)*
Prevalence (95% confidence intervals)Rate / Lower / Upper
England
East Midlands / 1.3 / 0.9 / 1.8
East of England / 4.7 / 3.9 / 5.4
London / 1.3 / 0.9 / 1.6
North East England / 4.1 / 3.0 / 5.1
North West / 1.2 / 0.9 / 1.5
South Central / 4.6 / 3.7 / 5.4
South East Coast / 2.4 / 1.8 / 3.0
South West / 10.9 / 9.6 / 12.1
West Midlands / 2.0 / 1.5 / 2.5
Yorkshire and The Humber / 4.6 / 3.8 / 5.4
Wales / 4.8 / 3.7 / 5.9
* Only children who were discharged alive to wards within the same hospital or died on the AICU (i.e. children not transferred out to a PICU) were included in this analysis. Mid-2010 population estimates were derived from Office of National Statistics data (