Outcome of children admitted to adult intensive care units in Italy between 2003 and 2007

Background: Centralisation of critically ill children to paediatric intensive care units is supported by a strong rationale, but evidence is not overwhelming. Objective: To compare the outcome of children admitted to adult intensive care units (ICUs) in Italy between 2003 and 2007 with that of children admitted to paediatric intensive care units (PICUs) in Italy between 1994 and 1995. Methods: Prospective, multicenter cohort study and historical controls. Risk of ICU mortality was assessed with the PRISM score in both study and historical control groups. Descriptive statistics, standardized mortality ratios (SMRs) with their 95% confidence intervals, and the calibration plots were reported. Results: A total of 1,265 children admitted to 124 adult ICUs between 2003 and 2007 were compared with an historical control group formed by 1,533 children admitted to 26 PICUs between 1994 and 1995. The PRISM score slightly underestimated hospital deaths for low-risk patients in both groups. The overall SMR was 1.11 (95% CI 0.91-1.31) for adult ICUs and 1.04 (95% CI: 0.88-1.19) for PICUs. Conclusions: The level of care provided nowadays to children admitted to adult ICUs in Italy is similar to that provided by Italian PICUs 10 years earlier. On the other hand, there is evidence that Italian PICUs have improved the level of care in the same period. These findings, if confirmed, suggest a better quality of care for children admitted to PICUs as compared to adult ICUs and support the indication, when possible, of early referral to more specialized units in countries where paediatric intensive care is not centralised.