Slater A

Beca J

Croston E

McEniery J

Millar J

Norton L

Numa A

Schell D

Secombe, Paul

Straney L

Young P

Yung M

Gabbe B

Shann F

2022-08-29

OBJECTIVES: To describe regional differences and change over time in the degree of centralization of pediatric intensive care in Australia and New Zealand (ANZ) and to compare the characteristics and ICU mortality of children admitted to specialist PICUs and general ICUs (GICUs). DESIGN: A retrospective cohort study using registry data for two epochs of ICU admissions, 2003-2005 and 2016-2018. SETTING: Population-based study in ANZ. PATIENTS: A total of 43,256 admissions of children aged younger than 16 years admitted to an ICU in ANZ were included. Infants aged younger than 28 days without cardiac conditions were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was risk-adjusted ICU mortality. Logistic regression was used to investigate the association of mortality with the exposure to ICU type, epoch, and their interaction. Compared with children admitted to GICUs, children admitted to PICUs were younger (median 25 vs 47 mo; p < 0.01) and stayed longer in ICU (median 1.6 vs 1.0 d; p < 0.01). For the study overall, 93% of admissions in Australia were to PICUs whereas in New Zealand only 63% of admissions were to PICUs. The adjusted odds of death in epoch 2 relative to epoch 1 decreased (adjusted odds ratio [AOR], 0.50; 95% CI, 0.42-0.59). There was an interaction between unit type and epoch with increased odds of death associated with care in a GICU in epoch 2 (AOR, 1.63; 95% CI, 1.05-2.53 for all admissions; 1.73, CI, 1.002-3.00 for high-risk admissions). CONCLUSIONS: Risk-adjusted mortality of children admitted to specialist PICUs decreased over a study period of 14 years; however, a similar association between time and outcome was not observed in high-risk children admitted to GICUs. The results support the continued use of a centralized model of delivering intensive care for critically ill children.

Department of Paediatric Intensive Care Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.

Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

School of Clinical Medicine, The University of Queensland, South Brisbane, QLD, Australia.

Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.

Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.

Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.

Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.

Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.

Department of Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.

Children's Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia.

Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia.

Intensive Care Unit, Alice Springs Hospital, Central Australia Health Service, Alice Springs, NT, Australia.

School of Medicine, Flinders University, Darwin, NT, Australia.

Medical Research Institute of New Zealand, Wellington, New Zealand.

Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.

Department of Paediatric Critical Care, Women's and Children's Hospital, Adelaide, SA, Australia.

Discipline of Paediatrics, University of Adelaide, Adelaide, SA, Australia.

Pediatr Crit Care Med . 2022 Nov 1;23(11):919-928. doi: 10.1097/PCC.0000000000003060. Epub 2022 Aug 29.

https://pubmed.ncbi.nlm.nih.gov/36040098/?otool=iaurydwlib

https://hdl.handle.net/10137/12262

Australia / epidemiology

Child

Cohort Studies

Critical Care

Hospital Mortality

Infant

Intensive Care Units

New Zealand / epidemiology

Retrospective Studies

Association Between Centralization and Outcome for Children Admitted to Intensive Care in Australia and New Zealand: A Population-Based Cohort Study.

Journal Article

Publication