Volume–Outcome Relationships in Pediatric Intensive Care Units

(1) Literature review

Title – Has centralisation improved the neurological outcome of children requiring intensive care services in Yorkshire and Humber?

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Introduction

Describe how or why you chose this area to research. This may relate to your clinical area of interest, a personal experience or your having a question that you feels need answering. Think through the information you require to undertake your research or the questions you need to answer. It is important to be clear and focused, rather than broadly covering the whole clinical area

The aim of the paediatric intensive care is to prevent mortality in children with critical illness and preserve functional outcomes. We want to see if the centralisation has improved the morbidity and neurological outcome of children requiring intensive care by comparing outcome before (2003-2007) and after centralisation (2008-2011).

As we know from the literature papers as early as 1997 Pearson etal¹ showed that the substantial reduction in the mortality rates can be achieved if every UK child who needed intubation for 12-24hrs is admitted to one of the specialist Paediatric ICU

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With the improvements in critical care services although patients are surviving, they may have increased morbidity or secondary admissions with sepsis. It appears that Paediatric critical care may have exchanged improved mortality rates for increased morbidity rates². From the recent PICANet data (A decade of data.2014 Annual Summary Report) PICU mortality is running all time low and it is less sensitive as a key performance indicator but it is the post PICU morbidity that is more important. We also have to understand that increasing number of children with poor functional status has implications not only on the rest of the life of the child but also on the family and NHS in terms of providing adequate individual support both medically and financially

As a result of changes in service provision from 2008 in Yorkshire and Humber, the establishment of a dedicated regional retrieval service, more patients were transferred out, using a guideline or matrix, backed up by consultant discussion with transport teams and regional centre.

PICU care was undertaken in one DGH (Hull Royal Infirmary) according to the model given for Acute Major General Hospital in Troop Report, as a hub and spoke arrangement with the regional centre. We want to do a retrospective cohort study looking at two groups pre and post centralization (2003-2007 vs 2008-2011). This information will guide us in improving the standards of our care towards critically ill children

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Questions : Itemise the questions you are addressing in the review?

1. Has centralization affected the mortality and morbidity of critically ill children?

Search Strategy
Describe your search strategy, indicating the databases you used, the key words and the sort of studies you were looking for. Indicate how many articles you identified and why you choose the studies to review that you did. A systematic review is not required. but you are expected to have adopted a strategy that one might reasonably expect a clinician to take in the course of their work

Primary Source: Medline
Secondary Source: Pubmed, Pediatric Critical Care Medicine Journal

Review of the literature

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Provide us with the answers to your questions. It helps to take each question in turn. Present the evidence you have found concisely, critically and clearly. It is sensible to summarise the studies in the form of table (which may include a column for comments on the quality of the study in question). This means that you can provide a your conclusions in a paragraph following the table. If there is no evidence for any question, then say so

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