Paediatric Intensive Care Unit

Advances in paediatric intensive care have resulted in the improvement of prognosis of critically ill children. Over the last decade, there has been a general improvement in mortality in paediatric intensive care units (PICUs), (Carcillo JA, 2006). In a recent study by Namachivayam et al (2010) which examined the characteristics of children admitted to PICUs in Australia in 2005 and 2006 and trend and long-term outcomes of children admitted to PICU in 1982, 1995, and 2005 to 2006 reported a 21% increase in the proportion of children over 1 year of age who were admitted to PICU and who had a pre-existing disability. The authors also reported a decrease in mortality at the expense of a large increase in the number of children with moderate or severe long-term disability, particularly in the non-cardiac patients. The proportion of children with moderate or severe disability increased from 8.4% in 1982 to 17.9% in 2005-2006; a significant increase of 112% which the author state could not be accounted for solely by the pre-existing disability. Thus, the high cost of treatment and poor outcome in children admitted to PICU is of great concern. In the UK, trends over time have been much more easily examined since the establishment of the Paediatric Intensive Care Audit Network (PICANet) in 2002; an audit database recording details of the treatment of all critically ill children in NHS PICUs in England, Wales and Scotland (PICANet Annual Report, 2010). Trends of mortality following admission to paediatric intensive care in the UK showed a decrease of 3% from 4.8% in 2007 to 4.5% in 2009 and as a result of this the morbidity burden may be great. There is a concern that intensive care may be keeping individuals alive in very poor states of functional health for significant lengths of time. There is also a concern that survivors impose significant burden and possibly ill health upon the family of the patient. The implication is that morbidity is more relevant than mortality when comparing outcomes between groups of patients in PICUs, and that the life expectancy of the survivors may understate the impact of post PIC morbidity in children (NHS Executive Leeds 1997).

1.2 ROLE OF PICANET IN RISK ADJUSTMENT

PICANet was established in 2002 from funding by the Department of Health (DOH) in order to provide a national database of paediatric care activity. It provides clinical audit of paediatric intensive care activity which aims to improve patient outcome by providing information on delivery of care to critically ill children and an evidence base for clinical governance. (PICANet, 2010) More specifically, PICANet aims to:

* identify best practice

* monitor supply and demand

* monitor and review outcomes of treatment episodes

* facilitate strategic