Critical Care for Children in a District General Hospital: A Review of the Caseload and Outcomes

Coakes, James; Gain, Carol; Craig, Gordon

doi:10.1177/175114371101200413

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…3 Respiratory and neurological presentations were the most common in this study, which is reflected in findings elsewhere. 2 In our study, 8% of patients were coded as presenting with out-of-hospital cardio-pulmonary arrests (OHCA), which likely reflects a range of leading causes including sudden infant death syndrome (SIDS; 'cot/crib death'), respiratory arrest, choking, trauma and sepsis. 6 The mortality rate of 7% of critically unwell children is similar to findings published in a previous survey (of 8%).…”

Section: Discussionmentioning

confidence: 98%

“…1 This centralisation of paediatric intensive care has been facilitated by specialist PICU retrieval services which provide acute care management advice and transport for critically ill children to a tertiary PICU. 2 However, critically ill children who present to district general hospitals (DGHs) are still likely to be admitted to AICUs for resuscitation, initial treatment and stabilisation until they are retrieved. 3,4 The General Medical Council (GMC) of the United Kingdom officially approved paediatric intensive care medicine as a recognised subspecialty of intensive care medicine only in 2018, and while there is a mandatory three month block of paediatric intensive care medicine in the Stage 2 of intensive care medicine training, the Paediatric Intensive Care Society (PICS) guidelines further highlight the need for continuing professional development (CPD) for doctors.…”

Section: Introductionmentioning

confidence: 99%

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Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

Spencer

Gumley

Pachucki

2021

Journal of the Intensive Care Society

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Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

Spencer

Gumley

Pachucki

2021

Journal of the Intensive Care Society

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“…При оценке амплитуды движения в суставах поврежденной конечности нормальная подвижность у детей основной группы наблюдалась в 2,8 раза чаще, чем в контрольной. Уменьшение объема движений в пределах 50-95 % нормы встречалось в группе контроля в 3 раза чаще (22 vs 7; р < 0,001), трофические изменения мяг-ких тканей поврежденной конечности и гипотрофии выявлены в 3 раза чаще (39 vs 11 Именно сроки оказания специализированной анестезиолого-реанимационной и травматологической помощи, направленной на устранение острой массивной кровопотери и жизнеугрожающих травматических повреждений, являются основ ными факторами, определяющими исход поли травмы у детей [28,29].…”

Section: дизайн исследованияunclassified

Algorithm of medical care for children with polytrauma

Yunusov

Ильдусович²,

Aleksandrovich

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Backgrоund. Polytrauma is the main reason for incapacitation and death in children of all ages. The appropriate timing of specialized medical care plays a crucial role for the outcomes of the polytrauma. Aim. The aim of the study is to analyze the results of the treatment of musculoskeletal injuries with the use of a decision-making algorithm in pediatric patients with polytrauma. Materials and methods. This is a prospective, observational, controlled, single-center study. The research included 130 children who were divided into two groups. In the main group, the children were provided with specialized medical care by a multidisciplinary team. After stabilization, the patients were transferred to a specialized center for final surgical treatment by minimally invasive fracture osteosynthesis. After the elimination of existing life-threatening conditions and the fitting of skeletal traction, the patients in the control group received surgical treatment only after transferal to a specialized center. Results. In the main group, pain regressed significantly earlier (1.7 0.6 vs 3.2 0.4, p 0.05), and the duration of the postoperative ICU stay was significantly reduced (1.5 0.9 vs 2.4 1.4 days, p 0.05). The optimization of the surgical treatment of injuries facilitated a reduction in the duration of the ICU stay of patients in the main group (5.6 0.3 vs 6.5 0.4 days), in the surgical department (21.5 0.7 vs 25 0.9 days), and the overall hospital stay (up to 27.5 days). Conclusions. This study developed a decision-making algorithm for administering medical care to children with polytrauma based on the principle of stabilization of the condition and early low-trauma surgery in the hours following injury.

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“…3 As such, it is not surprising that a recent review of case workload in a DGH demonstrated a relatively low exposure to the management of critically unwell children, an average of eight patients per consultant over a 12 months period. 4 The challenges of caring for these children extend beyond the clinical management but also require a sound understanding of the relevant medico-legal principles.…”

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confidence: 99%

Medico-legal issues for intensivists caring for children in a District General Hospital

Griffiths

Danbury

2015

Journal of the Intensive Care Society

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Anaesthetists and intensivists are often called upon to assist with the care of acutely unwell children presenting to district general hospitals. Treatment is usually provided with the consent of a parent but it may be required to treat the child using the doctrine of necessity. In this article we discuss aspects of the law, as it relates to children, to enable teams, who predominately treat sick adults, understand the legal framework surrounding the treatment of sick children.

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Critical Care for Children in a District General Hospital: A Review of the Caseload and Outcomes

Cited by 4 publications

References 3 publications

Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

Algorithm of medical care for children with polytrauma

Medico-legal issues for intensivists caring for children in a District General Hospital

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