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The epidemiology of children a'dmitted to paediatric intensive care units (I?tcUs) in England and Wales is described, focussing on the effect of deprivation and ethnicity on admission prevalence and mortality. The effects on mortality of size of the admitting unit, admission time, day of the week and season on mortality are investigated. The performance of the mortality risk-adjustment model is discussed in relation to other casemix factors including diagnosis, genetic ancestry and institutional characteristics. An analysis of the epidemiology of children admitted to intensive care with severe traumatic brain injury provides more detailed insight into this important subset of the paediatric intensive care population. In 2004-2005, there were 27859 admissions to paediatric intensive care in England and Wales involving over 20,000 children (under 16 years), 10% of whom ~ere classified as south Asian. Nearly half of all children admitted were under one year of age. Incidence for admission was 55% higher for south Asian children and was 71% higher in the most deprived fifth of the population compared with the least deprived. Deprivation is also associated 'Yith higher admission rat~s to paediatric intensive care for severe traumatic brain injury. Risk-adjusted mortality did not significantly increase with increasing deprivation but mortality in south Asian children was raised, especially in the least deprived fifth of the population. ~isk-adjusted mortality is higher in winter in I~Jrger PICUs and weekend admissions have higher mortality compared to weekdays in smaller PICUs. Mortality following admission to· PICU with a severe traumatic brain injury is highest in those injuries involved with motor vehicles but does not increase with deprivation. The data and analyses represent noveJ'information on the population characteristics of childre[l receiving paediatric intensive care in England and Wales, the effect of these on mortality, and the relationship between service provision and mortality. |
