Teenagers: paediatric or adult ICU?

Introduction

The present study aims to compare the diagnostic categories and outcomes for teenagers admitted to the paediatric ICU (PICU) and the adult ICU over a 3-year period. 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' [2]. To date, there are no specific national standards addressing the care of teenagers on intensive care.

Methods

All patients aged between 16 and 19 years of age admitted to both the adult ICU and the 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 two groups.

Results

A total of 50 and 46 patients aged between 16 and 19 years were admitted to the adult ICU and the PICU, respectively. The average predicted risk of mortality for those aged 16 to 19 years on the adult ICU was 3.98% and the actual mortality was comparable at 4%. On the PICU, the average predicted risk of mortality for those aged 16 to 19 years was 5.23% and the actual mortality for this age group was higher than predicted at 6.52%. On the PICU, 50% of the total admissions had a primary diagnosis of congenital disorder followed by 13% with neuromuscular disorders. On the 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 the adult ICU compared with none on the PICU.

Conclusion

The outcomes for patients aged 16 to 19 years are similar in both the PICU and the adult ICU; however, there is significant variation in the diagnostic profile. Further larger-scale studies are needed to develop a standardised and pragmatic approach to this age group of patients.