Children From Deprived Backgrounds Need Intensive Care
Children from the poorest areas are more likely to be admitted to intensive care – but are just as likely to survive as children from more affluent homes.
This is a key finding from the largest ever national audit of admissions to paediatric intensive care in England and Wales conducted by researchers at the University of Leeds and the University of Leicester.
This study also revealed that significantly more children from a south Asian background were admitted for intensive care treatment than would be expected compared to the general childhood population. Following admission to paediatric intensive care, survival for south Asian children was poorer than the rest of the population.
A team led by Dr Roger Parslow and Professor Tricia McKinney from the University of Leeds, and Professor Elizabeth Draper from the University of Leicester runs the Paediatric Intensive Care Audit Network (PICANet), a national database that collects details of all children admitted to paediatric intensive care in the UK. The group analysed the details of more than 40,000 children admitted to 29 paediatric intensive care units in England and Wales over the four years to 2007.
The study found that about one in a thousand children in England and Wales were admitted to paediatric intensive care in those four years. But children from the poorest fifth of the population were almost twice as likely to be admitted as those from the most affluent fifth.
The team used information on how ill each child was on admission to estimate their risk of death. This risk-adjustment is similar to the method employed to compare performance between schools where there are differences in the ability of pupils admitted. Using this method, they found that risk-adjusted mortality was not higher in children from the poorest areas.
Admission rates to paediatric intensive care of children from south Asians families were 36% higher than for the rest of the population. In this group, risk-adjusted mortality rises as affluence increases.
The authors said the research raises issues which require further investigation: “What comes across quite clearly from this research is that more children from poorer areas are admitted to paediatric intensive care. This confirms data on existing health inequalities in England and Wales,” said Dr Parslow, Senior Lecturer in the Paediatric Epidemiology Group at the University of Leeds.
“Critical illness or injury is harrowing for the child and extremely distressing and disruptive for their parents,” he said. “Any initiative that could reduce the need for admission to paediatric intensive care would reduce the burden on these parents and children.”
That would also deliver economic benefits. This level of treatment is expensive: a paediatric intensive care bed costs the NHS between £1,200 and £4500 per day.
Dr Parslow said their research proved that this area of the health service was very effective. “Even though paediatric intensive care units admit more children from poorer backgrounds, those children are not more likely to die than someone from a more affluent group. There is clearly no inequality in the treatment children receive based on their social background.”
He said there was no explanation as to why children from south Asian backgrounds were more likely to access paediatric intensive care, or why the risk-adjusted mortality rate for this group increased as deprivation decreased. More research was crucial.
“We should be looking at these children in more detail to see if there are other interventions which may help them.”
The Paediatric Intensive Care Audit Network (PICANet) is funded by the Healthcare Quality Improvement Partnership (HQIP), Health Commission Wales Specialised Services, NHS Lothian / National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, and the Pan Thames PICU Commissioning Consortium. The research is published in Archives of Disease in Childhood and ties in with the Government’s commitment to address the links between deprivation, ethnicity and poor health.
“This is the first truly national audit of paediatric intensive care,” Dr Parslow said. “It has a very high quality dataset which has brought to light a number of important issues which should now be examined in more detail.”