Abstract
There are global variations in policies that define clear indications for PICU (Pediatric Intensive care unit) admissions. In resource limited countries where PICU service availability is limited, the admission criteria to PICU are urgently needed to optimize the utilization of available intensive care services and to maximize patient benefit. The objective of these consensus recommendations on PICU admission criteria is to provide a framework and reference for future policy development by professional societies and governments. Design: The consensus recommendations were developed by a multidisciplinary consensus task force comprised of international experts in pediatric critical care, emergency medicine, trauma, critical care, and health policy stakeholders during the 2016 annual INDUSEM WORLD CONGRESS in Bengaluru, India. Measurements and main results: A task force steering committee completed a global literature search about PICU admission criteria development; reviewed PICU admission guidelines published by a variety of professional organizations worldwide, and performed a literature review of relevant publications. The objectives of this Task Force is to provide a framework for validated approach to determine appropriateness of ICU admission in India(resource limited setting) based on a) prioritization modeling; b) general clinical criteria; c) clinical and objective parameters and d) other criteria. The expert consensus panel then discussed and ranked proposed criteria according to scientific evidence, current standard of care, and expert opinion in the context of the Indian health system. The general subject was addressed in sections: admission criteria and benefits of different levels of care, following the appraisal of the literature, discussion, and consensus, recommendations were written. Conclusion: Although these are consensus recommendations, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. The scarcity of high-quality evidence made it difficult to answer all the questions asked related to ICU admission. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission process. This publication is designed to assist in future development of health policies to ensure effective resource allocation, maximize healthcare benefits and improve access to quality care for children.
Highlights
The PICU concept was initially developed about 40 years ago with the first consensus conference on critical care admission held in 1983 by the National Institute of Health in the US [1,2]
The principle that emerged from this group continues to be relevant even today as it identifies patients who should be admitted to the PICU as those who “reversible medical conditions with a reasonable prospect of substantial recovery” [3,4]
Severity of illness scores such as the Pediatric Risk of Mortality Score (PRISM), Acute Physiology and Chronic Health Evaluation (APACHE), and Simplified Acute Physiology Scoring (SAPS) are inadequate and not validated to predict which patients are likely to benefit from intensive care. [8,9,10,11]
Summary
The consensus process applied is based on a previous approach by the Society of Critical Care Medicine [21], defining PICU admission criteria in high resource environments These consensus recommendations were developed by a consensus panel task force team comprised of Indian and international experts in pediatric critical care, emergency medicine, trauma, and health policy stakeholders. The authors see this publication as a reference and starting point for institutions who are interested in engaging in the process of defining PICU admission criteria These recommendations are not designed or intended to serve as ethical or medico-legal criteria to be applied to decide about “appropriateness” of care, placement of patients and transfer of patients and are not meant to replace clinical judgment and the local definition of appropriate care.
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