Changes in the profile of paediatric intensive care associated with centralisation

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Abstract
Objectives: To compare intensive care admissions from a defined population of children in 1991 and 1999, during a period of organisational change and centralisation of paediatric intensive care. Design: Two 12-month population-based audits were compared. Data were collected from hospitals in Birmingham and the surrounding districts. Denominator data were obtained from the Office for National Statistics. The place and rate of intensive care admission, the use of mechanical ventilation at admission, mortality and length of stay were compared. Setting: Hospitals in the West Midlands. Participants: All children (Measurements and results: The number of Birmingham resident children admitted for intensive care increased from 277 to 510 (ppp=0.0117). Child mortality fell over this period by 34 deaths per 100,000 children (95%CI 16–51, pConclusions: Centralisation by expansion of the lead centre was associated with a large increase in the numbers of children receiving intensive care consistent with an unmet need for paediatric intensive care in 1991, which may still exist. Centralisation of paediatric intensive care may have contributed to the fall in child mortality over this time period.

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