Demand Analysis of Paediatric High Dependency Unit (PHDU) for Acute Neurological Morbidity: Experience of an Irish Regional Unit Over 7 Years

Background: Paediatric high dependency units (PHDU) care for children who are not unwell enough to be admitted to the Intensive Care Unit (ICU) but require close monitoring and treatments which cannot be provided safely in the general paediatric ward. Acute neurological deterioration among infants and children often require the support from PHDU/ICU, however there is paucity of literature on the true demand for paediatric critical care needs during acute neurological presentations among infants and children. Our study aim is to develop a demand modeling for acute neurological morbidities based on an annual regional birth rate and a childhood population (<16years) for the Mid-West of Ireland.

Method: Prospectively collected PHDU admission data covering a seven year period was analysed including demographics, diagnosis, management received, length of stay (LOS) and transfer outcomes. Data was verified with computerized hospital inpatient enquiry (HIPE) and analysed using SPSS version 21.

Results: Over the study period (27%) of primary diagnosis was of the acute neurological category. Convulsions contributed to the highest occupancy, followed by encephalopathy and least common were surgical/head-injury patients. 53% were male and 46% female, with a significant contribution by infants and overall majority being under 10 years of age. Median LOS was 2.6 days. In addition to anticonvulsants (10.3%) needed non-invasive respiratory support and (5.1%) required endotracheal intubation and ventilation. Two mortalities occurred, 9% required transfer to ICU/PICU. We estimated a mean annual admission demand of 33 to PHDU for acute neurological presentations requiring 86 bed days per 100,000 childhood population.

Conclusion: Our study provides supportive evidence for rationalization in developing critical care facilities available to assist acute care of paediatric neurological patients. Additionally, our observations highlight the PHDU demand of clinical staff to manage those during acute deterioration at regional centres, thus supporting their safe care locally with obvious health economic benefits.