ArticleBritish journal of neurosurgery2011
Severe head injury in children: intensive care unit activity and mortality in England and Wales.
Article in British journal of neurosurgery, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 32 citations in OpenAlex.
- Effects of establishing a trauma center on the mortality rate among injured pediatric patients in Japan.PloS one · 2019Trial
- Variation in intracranial pressure monitoring and outcomes in pediatric traumatic brain injury.Archives of pediatrics & adolescent medicine · 2012Trial
- Pediatric admissions that include intensive care: a population-based study.BMC health services research · 2018Article
- Challenges and opportunities for pediatric severe TBI-review of the evidence and exploring a way forward.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2017Review
- Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Observational
- Monitoring the changing pattern of delivery of paediatric epilepsy surgery in England--an audit of a regional service and examination of national trends.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2015Article
- Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2014Article
- CT characteristics, risk stratification, and prediction models in traumatic brain injury.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2014Article
- Differences in medical therapy goals for children with severe traumatic brain injury-an international study.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2013Article
- Parent perceptions of early prognostic encounters following children's severe traumatic brain injury: 'locked up in this cage of absolute horror'.Brain injury · 2013Article
- Osmolar therapy in pediatric traumatic brain injury.Critical care medicine · 2012Article
- Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo explore the relationship between volume of paediatric intensive care unit (PICU) head injury (HI) admissions, specialist paediatric neurosurgical PICU practice, and mortality in England and Wales.
methodsAnalysis of HI cases (age <16 years) from the Paediatric Intensive Care Audit Network national cohort of sequential PICU admissions in 27 units in England and Wales, in the 5 years 2004-2008. Risk-adjusted mortality using the Paediatric Index of Mortality (PIM) model was compared between PICUs aggregated into quartile groups, first to fourth based on descending number of HI admissions/year: highest volume, medium-higher volume, medium-lower volume, and lowest volume. The effect of category of PICU interventions - observation only, mechanical ventilation (MV) only, and intracranial pressure (ICP) monitoring - on outcome was also examined. Observations were reported in relation to specialist paediatric neurosurgical PICU practice.
resultsThere were 2575 admissions following acute HI (4.4% of non-cardiac surgery PICU admissions in England and Wales). PICU mortality was 9.3%. Units in the fourth-quartile (lowest volume) group did not have significant specialist paediatric neurosurgical activity on the PICU; the other groups did. Overall, there was no effect of HI admissions by individual PICU on risk-adjusted mortality. However, there were significant effects for both intensive care intervention category (p<0.001) and HI admissions by grouping (p<0.005). Funnel plots and control charts using the PIM model showed a hierarchy in increasing performance from lowest volume (group IV), to medium-higher volume (group II), to highest volume (group I), to medium-lower volume (group III) sectors of the health care system.
conclusionsThe health care system in England and Wales for critically ill HI children requiring PICU admission performs as expected in relation to the PIM model. However, the lowest-volume sector, comprising 14 PICUs with little or no paediatric neurosurgical activity on the unit, exhibits worse than expected outcome, particularly in those undergoing ICP monitoring. The best outcomes are seen in units in the mid-volume sector. These data do not support the hypothesis that there is a simple relationship between PICU volume and performance.
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