Does treatment for paediatric status asthmaticus before PICU admission differ between district general hospital and a regional centre in the Northwest of England? A thirteen-year retrospective cohort study

Introduction It has been suggested that children receive less drug treatment prior to intubation and ventilation in district hospitals than in tertiary hospitals with the Paediatric Intensive Care Unit (PICU) on site (Carroll et al. Ped Crit Care Med 2007;8(2):91). The PICU at Alder Hey Children’s Hospital serves as a regional unit for the north west of England and North Wales in addition to providing secondary care to the local population. Aims and Objectives To assess the premorbid state of children admitted to the PICU at Alder Hey and compare pre-admission treatment received by children transferred from district hospitals to those admitted from within the hospital. Methods Retrospective cohort study of all children with admission coded as asthma, admitted to Alder Hey PICU between 1998 and 2011. Results 83 children met the inclusion criteria. 61 case notes were available. 43 patients required intubation; 30 from district generals and 13 from Alder Hey. Premorbid states and maintenance therapy were comparable between district hospital admissions and within Alder Hey. Children from the district hospitals received more intravenous therapies prior to transfer or intubation and ventilation; Magnesium sulphate 38.2% vs. 11.1% and Intravenous salbutamol 38.2% vs. 7.4%. They also required shorter periods of intubation; mean 37.1 hours vs. 43.4 hours. Conclusion Children with status asthmaticus at a district hospital with no PICU on site received more drug treatment prior to intubation and were ventilated for less time.