Teenagers: paediatric or adult ICU?

Abstract

INTRODUCTION: The UK Paediatric Intensive Care Society has agreed consensus standards for the care of critically ill patients up to the age of 16 years [1]. The UK National Service Framework for Children defines a child as 'all those under 19 years of age' [2]. To date, there are no specific national standards addressing the care of teenagers on Intensive Care. OBJECTIVES: This study aims to compare the diagnostic categories and outcomes for teenagers admitted to the Paediatric Intensive Care Unit (PICU) and Adult Intensive Care Unit over a 3-year period. METHODS: All patients aged between 16-19 years of age admitted to both Adult ICU and PICU were retrospectively enrolled between January 2005 and June 2008. A revised version of the Paediatric Index of Mortality (PIM2) was used to calculate predicted mortality in the 2 groups. RESULTS: A total of 50 and 46 patients aged between 16-19 years were admitted to the Adult ICU and PICU respectively. The average predicted risk of mortality for those aged 16-19 years on Adult ICU was 3.98% and the actual mortality was comparable at 4%. On PICU, the average predicted risk of mortality was 5.23% and the actual mortality was higher than predicted at 6.52%. On PICU, 50% of the total admissions had a primary diagnosis of congenital disorder followed by 13% with Neuromuscular disorders. On Adult ICU, trauma accounted for 31% of total admissions, followed by Diabetic ketoacidosis at 17%. Interestingly, self-harm/overdose accounted for 11.5% of teenage admissions to Adult ICU compared with none on PICU. CONCLUSIONS: The outcomes for patients aged 16-19 years are similar in both Paediatric and Adult Intensive Care. However, there is significant variation in the diagnostic profile. Further larger scale studies are needed to develop a standardised and pragmatic approach to patients aged 16-19 years