Summary Report
Source: data.gov.uk (2023-03-23)

PICANet Annual Report 2019-2021. Paediatric Intensive Care Audit - This data contains information on all admissions to Paediatric Intensive Care units in the UK and Ireland 2019-2021.

1 
 
 
 
 
 
 
 
 
 
Summary Report 
Paediatric Intensive Care 
Audit Network 
State of the Nation Report 2022 
Data collection period  
January 2019 – December 2021 

PICANet State of the Nation Report 2022  
 
2 
 
 
Published in the UK by the Paediatric Intensive Care Audit Network (PICANet). This work is copyright. Apart from any 
use as permitted under the Copyright, Designs and Patents Act 1988, no part may be reproduced by any process without 
permission from PICANet. 
Requests and enquiries concerning reproduction rights should be directed to PICANet at: 
PICANet, Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT 
Telephone xx-xxxx-xxxx ∙ Email xxx@xxx.xx 
In all cases, PICANet must be acknowledged as the source when reproducing or quoting any part of this publication. 
Please use the following format when citing this report: Paediatric Intensive Care Audit Network State of the Nation 
Report 2022 (published March 2023): Universities of Leeds and Leicester 
For this report content is © 2023 Healthcare Quality Improvement Partnership (HQIP) 
The ISBN number for this publication is 978-0-85316-365-7 
 
Contents 
Online resources ................................................................................................................................. 2 
Introduction ......................................................................................................................................... 3 
Key messages .................................................................................................................................... 3 
National Recommendations ................................................................................................................ 4 
Improvement resources ...................................................................................................................... 5 
Admissions to Paediatric Intensive Care Units ..................................................................................... 6 
Mortality within PICUs ......................................................................................................................... 8 
Key metrics ......................................................................................................................................... 9 
Metric 1: Case ascertainment and timeliness of data submission.............................................................. 9 
Metric 2: Retrieval mobilisation times ....................................................................................................... 9 
Metric 3: Emergency readmissions within 48 hours .................................................................................10 
Metric 4: Unplanned extubation in PICU ..................................................................................................11 
Metric 5: Mortality in PICU ......................................................................................................................12 
Organisation key .....................................................................................................................................13 
 
Online resources  
We have a range of resources to accompany this report online. 
The Infographic highlights some of the report’s key findings in relation to paediatric critical care 
activity between 2019 and 2021.  
A set of tables and figures document transport, referrals and admissions activity within paediatric 
critical care between 2019 and 2021. 
The Appendices contain acknowledgements to the paediatric critical care community, background 
information and methodology about the audit.   
New for 2022, we have introduced a dedicated Quality Improvement webpage with resources for 
participating organisations. 
 

PICANet State of the Nation Report 2022  
 
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Introduction 
This is the nineteenth PICANet annual clinical audit report describing paediatric critical care activity 
which occurred within paediatric intensive care units in the United Kingdom (UK) and Republic of 
Ireland (ROI) between 2019 and 2021. This year we present the first PICANet ‘State of the Nation’ 
Report, cataloguing comprehensive information on referral, transport and admission events to 
monitor the delivery and quality of care in relation to agreed standards and evaluate clinical 
outcomes to inform national policy in paediatric critical care. 
We report on five key metrics relevant to Paediatric Intensive Care services: case ascertainment 
including timeliness of data submission, retrieval mobilisation times, emergency readmissions 
within 48 hours of discharge, unplanned extubation in PICU and mortality in PICU. Unplanned 
extubation in PICU is introduced as a new metric this year.   
We also plan more regular and focused outputs, moving towards quarterly updates of the ‘PICANet 
Metrics online’ from quarter four 2023 onwards as well as enhancements to the PICANet web 
platform in the form of online dashboards. 
The PICANet National Paediatric Critical Care Audit is commissioned by the Healthcare Quality 
Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes 
Programme (NCAPOP), the Welsh Health Specialised Services, NHS Lothian/NHS Greater 
Glasgow and Clyde, the Royal Belfast Hospital for Sick Children, The National Office of Clinical 
Audit (NOCA) for the Republic of Ireland and HCA Healthcare UK. 
 
Professor Elizabeth S Draper 
Professor Richard Feltbower 
Principal Investigators 
 
Key messages 
 
The number of admissions to paediatric intensive care across the UK and Republic of 
Ireland (ROI) increased by 11% from 16,540 in 2020 (following the start of the COVID-19 
pandemic) to 18,320 in 2021. This increase was reflected across all countries of the UK 
and ROI, although remained 10% below pre-pandemic levels in 2019.  
 
The rise in admissions in 2021 was also reflected by a similar increase in the number of 
bed days delivered across the UK and ROI, which increased by 10% in 2021 compared to 
2020 (from 63,271 to 69,570 bed days).  
 
Two-thirds of admissions to PICUs occurred in those aged under 5 years, with just over two 
in five admissions aged under 1 year. These proportions remained similar between 2019 
and 2021. 
 
The proportion of admissions which were of ‘Asian’, ‘Black’ or ‘Other’ ethnic minority origin 
increased from 17% to 25% between 2019 and 2021 with the proportion classified as 
‘White’ also increasing from 62% to 63% over this period. 
 
Completeness of known data on ethnic group improved from 82% in 2019 to 88% in 2021. 
 
Children from the most deprived areas were over-represented in admissions to PICU: 30% 
of all children from England and Wales came from the most deprived group of the 
population when split into five equal groups. However, only 14% of admissions came from 
the least deprived group. This pattern remained the same between 2019 and 2021. 

PICANet State of the Nation Report 2022  
 
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 
The proportion of admissions where children died in PICUs remained low, with 96.6% of 
admissions discharged alive in 2021. There was a fall in mortality from 3.6% of admissions 
in 2020 to 3.3% in 2021. The proportion of all deaths within PICU remained steady at 
around 15% in 2021, although this increased from 24% in 2020 to 27% in 2021 for PICU 
admissions in the ROI. 
 
Units across the UK and ROI provided complete and timely admissions data to PICANet 
within three months of discharge for 88% of all admissions in 2021. Twenty-four units 
achieved completeness within three months for at least 90% of their admissions in 2021, a 
slight increase from twenty-two units in 2020. Five units completed fewer than 60% of their 
admission records within this timescale compared to four units in 2020.  
 
The number of children requiring urgent transport to a PICU in 2021 increased from 3,073 
in 2020 to 4,324 in 2021, a similar number to 2019 (n=4,262). Of those journeys carried out 
in 2021, 65% were started within 30 minutes vs 64% in 2020 and 58% in 2019, whilst over 
80% started within one hour of the clinical decision being made. Just over 4% of journeys in 
2021 started more than three hours after the decision compared to 3% in 2020 and 6% in 
2019.  
 
The proportion of emergency readmissions within 48 hours of discharge for the UK and ROI 
combined remained stable throughout 2019-2021 at around 1.6%. Rates varied by country 
in 2021, from 1.4% in Wales to 2.1% in Scotland.  
 
Reported rates of unplanned extubations for the UK and ROI combined fell from 4.6 per 
1,000 days in 2019 to 4.2 in 2021. There was some variation in these figures with Northern 
Ireland reporting lower rates (2.4 per 1,000 days) and Scotland reporting higher rates (5.4 
per 1,000 days).  
 
There were no units identified as statistical outliers with higher than predicted mortality 
rates between 2019 and 2021. However, two units were identified as positive outliers for 
mortality, with substantially lower numbers of deaths than would be predicted. 
 
National Recommendations 
1. Ensure PICANet data submissions are completed within the PCCS Quality Standard; as 
soon as possible or within two months of discharge from PICU.  
Action: PCC Providers, PCC Operational Delivery Networks, Paediatric Critical Care 
Society, Specialised Commissioning NHSE 
2. Maintain high levels of recording of ethnicity, ensuring appropriate resource, for admissions 
to all PICUs and work towards a UK wide standardised recording of ethnicity, to enable 
PICANet to investigate health inequalities.  
Action: PCC Providers, NHS England, national data handlers in the other 
participating countries that support the improvement of data collection 
3. Investigate the reasons for the disproportionate numbers of admissions from the most 
deprived areas of the country. 
Action: Integrated Care Boards, Department of Health and Social Care, Department 
for Levelling Up, Housing and Communities, ROI equivalent government 
departments  
4. Develop a standard for comparing and evaluating rates of unplanned extubation. 
Action: Specialised Commissioning NHSE, Paediatric Critical Care Society, clinical 
community  

PICANet State of the Nation Report 2022  
 
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5. Review the barriers and facilitators of timely mobilisation of centralised transport teams to 
provide appropriate transport services for critically ill children. 
Action: PCC Operational Delivery Networks, Paediatric Critical Care Society Acute 
Transport Group, clinical community  
 
Improvement resources  
PICANet provide a variety of improvement resources for participating organisations. The dedicated 
Quality Improvement page on our website (https://www.picanet.org.uk/) signposts to these and the 
page is updated regularly. Some of the key quality improvement (QI) resources are: 
Risk-adjusted resetting sequential probability ratio test (RSPRT) plots 
PICANet conduct an annual formal outlier analysis for in PICU mortality and the outcome of this is 
included in the ‘mortality in PICU’ key metric section of our annual reports. We also continue to 
provide real-time ‘RSPRT’ plots to enable PICUs to monitor their mortality outcomes on a much 
more timely and regular basis. To support this, RSPRT Guidance for Units is available to assist 
PICUs in identifying and responding to potential issues with quality of care in a time-sensitive 
fashion. The guidance includes a case study from a PICU team that responded to a RSPRT reset 
which was a cause for concern requiring internal review. Further to the case study in the guidance, 
the PICANet Annual Meeting 2022 discussion session, PICANet RSPRT in PICU, is available on 
our website. This features two PICU clinicians talking about their experience of using RSPRT plots 
to monitor mortality in their units.  
 
Ethnicity data collection resources                                                                                    
Guidance and resources for asking about ethnicity, collecting and recording it are available from 
Ethnicity - NHS Digital, which signposts to Improving ethnicity data collection for health statistics in 
the UK (IQBAL, Gulnaz, GUMBER, Anil, JOHNSON, Mark R.D, SZCZEPURA, Ala, WILSON, Sue 
and DUNN, Janet A (2009). Improving ethnicity data collection for health statistics in the UK. 
Diversity and Equality in Health and Care, 6 (4), 267-285).  
 
Tables and figures 
Tables and figures are provided with each annual State of the Nation Report. These are provided 
here https://www.picanet.org.uk/annual-reporting-and-publications/ in an accessible Excel 
Workbook format and enable participating organisations to assess and monitor their performance 
against other PICUs or centralised transport services to inform local and regional quality 
improvement initiatives. They document the following activity and outcomes within paediatric 
critical care for the reporting period. 
 
Admissions to PICU  
 
Retrieval and transfer information collected from the PICU admission data 
 
Interventions received by children admitted to PICU 
 
Bed activity (bed days) and length of stay in PICU 
 
Outcomes of children admitted to PICU and Standardised mortality ratios (SMRs) 
 
Number of children admitted by diagnostic group 
 
Prevalence of admission to PICU 
 
Daily activity data, known as the Paediatric Critical Care Minimum Dataset (PCCMDS)  
 
Data quality  
 
Referral information for both transport to PICU and PICU admission  
 
Information on transports to PICU

 
6 
Admissions to Paediatric Intensive Care Units 
Table 1a: Admissions to PICU across UK & Republic of Ireland by socio-demographic characteristics and year of admission 
  
  
2019 
2020 
2021 
2019-2021 
  
  
n 
% 
n 
% 
n 
% 
n 
% 
Sex 
Male 
11,571 
56.7 
9,405 
56.9 
10,301 
56.3 
31,277 
56.6 
Female 
8,829 
43.3 
7,122 
43.1 
8,005 
43.7 
23,956 
43.4 
Total 
20,400 
36.9 
16,527 
29.9 
18,306 
33.1 
55,234 
  
Age group 
(years) 
<1 
8,652 
42.4 
7,026 
42.5 
7,463 
40.8 
23,141 
41.9 
1-4 
5,405 
26.5 
3,977 
24.1 
4,625 
25.3 
14,007 
25.4 
5-10 
3,346 
16.4 
2,747 
16.6 
3,014 
16.5 
9,107 
16.5 
11-15 
2,997 
14.7 
2,777 
16.8 
3,205 
17.5 
8,979 
16.3 
Total 
20,400 
36.9 
16,527 
29.9 
18,307 
33.1 
55,234 
  
Ethnicity 
White 
12,654 
62.0 
10,308 
62.4 
11,565 
63.2 
34,527 
62.5 
Mixed/Multiple ethnic groups 
597 
 2.9 
558 
 3.4 
668 
 3.6 
1,823 
 3.3 
Asian/Asian British 
2,141 
10.5 
1,865 
11.3 
2,167 
11.8 
6,173 
11.2 
Black/African/Caribbean/Black British 
834 
 4.1 
858 
 5.2 
1,019 
 5.6 
2,711 
 4.9 
Other 
488 
 2.4 
565 
 3.4 
736 
 4.0 
1,789 
 3.2 
Unknown 
1,082 
 5.3 
605 
 3.7 
474 
 2.6 
2,161 
 3.9 
Not stated 
2,604 
12.8 
1,768 
10.7 
1,678 
 9.2 
6,050 
11.0 
Total 
20,400 
36.9 
16,527 
29.9 
18,307 
33.1 
55,234 
  
Deprivation 
1 (Most deprived areas) 
4,630 
30.3 
3,798 
30.4 
4,104 
30.2 
12,532 
30.3 
2 
3,522 
23.0 
2,898 
23.2 
3,024 
22.2 
9,444 
22.8 
3 
2,726 
17.8 
2,303 
18.4 
2,533 
18.6 
7,562 
18.3 
4 
2,286 
15.0 
1,800 
14.4 
1,993 
14.6 
6,079 
14.7 
5 (Least deprived areas) 
2,117 
13.9 
1,710 
13.7 
1,955 
14.4 
5,782 
14.0 
Total 
15,281 
36.9 
12,509 
30.2 
13,609 
32.9 
41,399 
  
Country 
England (NHS) 
15,904 
78.0 
13,025 
78.8 
14,260 
77.9 
43,189 
78.2 
England (Non-NHS) 
304 
 1.5 
231 
 1.4 
240 
 1.3 
775 
 1.4 
Wales 
489 
 2.4 
363 
 2.2 
372 
 2.0 
1,224 
 2.2 
Scotland 
1,697 
 8.3 
1,178 
 7.1 
1,375 
 7.5 
4,250 
 7.7 
Northern Ireland 
492 
 2.4 
353 
 2.1 
443 
 2.4 
1,288 
 2.3 
Republic of Ireland 
1,514 
 7.4 
1,377 
 8.3 
1,617 
 8.8 
4,508 
 8.2 
Total 
20,400 
36.9 
16,527 
29.9 
18,307 
33.1 
55,234 
  
Children recorded as ambiguous sex are excluded from yearly totals within the sex category. 
Percentages are calculated within category by column, except for totals which are calculated across rows. 
Deprivation is calculated for residents of England and Wales admitted to PICU in those nations. Deprivation score is based on the location of residence of the child using the Children in 
low income measure (HMRC, 2014). Categories are equivalised to contain equal populations.  Where an address was unknown or score unavailable, the admission was excluded.  
Ethnicity categories are defined using Office for National Statistics definitions (Ethnic group, national identity and religion). 
‘Country’ refers to country of admission rather than residence of the child. 

 
PICANet State of the Nation Report 2022 
 
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Table 1a shows the number of admissions recorded in paediatric intensive care units (PICUs) 
across the UK and Republic of Ireland (ROI) according to socio-demographic factors by year of 
admission. Admissions to PICUs increased by 11% in 2021 compared to 2020, following the 
reduction in admission numbers resulting from the COVID-19 pandemic. The rise in admissions in 
2021 was mirrored across all UK nations and ROI.  However, overall admission numbers in 2021 
remained lower than those recorded in 2019 before the COVID-19 pandemic, with a breakdown 
provided according to diagnostic group summarised in Table 2. The proportion of admissions for 
PIC was higher for males (57%) than females (43%). Around 40% of all admissions were for 
children aged under 1 year with two-thirds of the total for those under 5 years of age. These 
proportions have remained constant over the reporting period. The proportion of all admissions 
aged 11-15 years increased from 15% in 2019 to 18% in 2021. There was a disproportionate 
number of admissions from the most deprived areas of England and Wales: 30% of admissions 
were from the most deprived fifth of the population whereas only 14% of admissions came from the 
least deprived fifth of the population. Although completeness of known ethnic group recorded on 
PICANet improved throughout the three-year reporting period from 82% in 2019 to 88% in 2021, 
there is still work to be done by PICUs to ensure that ethnicity data is provided for all admissions. 
There was an increase in the proportion of admissions recorded as ‘Asian’, ‘Black’ or ‘Other’ over 
time, from 17% in 2019 to 25% in 2021. However, changes in proportions of different ethnic groups 
of children admitted to PICU may be accounted for by the improved completeness of ethnic group. 
 
Table 1b shows that 69% of admissions to English units were of ‘White’ ethnic group compared to 
78% in the overall childhood population (ages 0-15 years).  
 
Table 1b: Admission rate per 10,000 population by ethnicity (England only)  
  
Avg annual admissions 
Child population 2020 
Admissions/ 
England 
n 
% 
n 
% 
10,000 pop 
White 
8,454 
69.0 
8,475,599 
78.1 
10.0 
Mixed/Multiple ethnic groups 
531 
4.3 
586,021 
5.4 
9.1 
Asian/Asian British 
1,909 
15.6 
1,106,928 
10.2 
17.2 
Black/African/Caribbean/Black British 
835 
6.8 
542,612 
5.0 
15.4 
Other 
516 
4.2 
141,079 
1.3 
36.6 
Total 
12,245 
10,852,239 
11.3 
Admissions are for an average year in the 3 year reporting period, and exclude admissions that had ethnicity recorded as 
‘unknown’ or ‘not stated’. 
Population is based upon 2020 mid-year population estimates (ONS, 2021). Population within each ethnic group is 
calculated using data from the 2011 census (table LC2109EWls).  
 
Table 2: Admissions by primary diagnostic group and year 
Primary Diagnosis 
2019 
2020 
2021 
Total 
Respiratory 
6,176 
3,575 
4,891 
14,642 
Cardiovascular 
5,278 
4,858 
4,739 
14,875 
Neurological 
2,401 
1,906 
2,101 
6,408 
Gastrointestinal 
1,214 
1,190 
1,140 
3,544 
Infection 
1,042 
803 
817 
2,662 
Musculoskeletal 
928 
715 
778 
2,421 
Oncology 
807 
784 
775 
2,366 
Endocrine / metabolic 
677 
808 
1,035 
2,520 
Other 
1,871 
1,883 
2,016 
5,770 
Unknown 
6 
5 
15 
26 
Total 
20,400 
16,527 
18,307 
55,234 
Although the general pattern of an 
increase in admissions in 2021 
following the pandemic of 2020 is 
reflected in most of the diagnosis 
groups, there was a consistent 
increase in admissions with endocrine 
/ metabolic diagnoses. In 2021 
following the pandemic, numbers of 
admissions for infection and oncology 
have remained in a steady state since 
2020.  

 
PICANet State of the Nation Report 2022  
 
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Mortality within PICUs 
Table 3: Proportion of deaths in PICU of all PICU admissions, by country and year of 
admission  
  
2019 
2020 
2021 
2019-2021 
Country of admission 
% 
n 
% 
n 
% 
n 
% 
n 
England 
 3.5 
576 
 3.7 
491 
 3.4 
494 
 3.6 
1,561 
Wales 
 2.0 
10 
 3.3 
12 
 4.0 
15 
 3.0 
37 
Scotland 
 1.9 
33 
 2.3 
27 
 1.7 
23 
 2.0 
83 
Northern Ireland 
 2.2 
11 
 2.0 
7 
 2.5 
11 
 2.3 
29 
Republic of Ireland 
 4.0 
60 
 3.9 
54 
 4.0 
65 
 4.0 
179 
Total 
 3.4 
690 
 3.6 
591 
 3.3 
608 
 3.4 
1,889 
 
Table 4: Proportion of deaths in PICUs of all children’s deaths in the population: UK and 
Republic of Ireland, 2019–2021 
  
2019 
2020 
2021 
2019-2021 
Country of admission 
% 
n 
% 
n 
% 
n 
% 
n 
UK 
15.9 
630 
14.7 
537 
14.2 
543 
15.0 
1,710 
Republic Of Ireland 
24.2 
60 
23.8 
54 
27.5 
65 
25.2 
179 
UK and Republic of Ireland 
16.4 
690 
15.2 
591 
15.0 
608 
15.5 
1,889 
 
Numbers of children who die when admitted to a PICU remain extremely low, with almost 97 in 
every 100 admissions surviving and being discharged alive (Table 3). The proportion of admissions 
which resulted in death whilst being treated in paediatric intensive care decreased from 3.6% in 
2020 to 3.3% in 2021. Around 15% of all childhood deaths in the UK occurred within a PICU 
although this figure was higher in the ROI (25%) and increased from 24% in 2019-2020 to 27% in 
2021 (Table 4). 
 

 
PICANet State of the Nation Report 2022  
 
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Key metrics  
Metric 1: Case ascertainment and timeliness of data submission 
Figure 1: Proportion of admission records completed within 3 months of discharge by PICU, 
2021 
 
    
 
 
   Organisation key 
 
Metric 2: Retrieval mobilisation times 
Figure 2: Number of non-elective transports to PICU by time to mobilisation: UK and 
Republic Of Ireland 2019-2021 
 
88% of admissions were 
completed within three 
months of discharge in 
2021 (Figure 1). This 
was similar in 2020 
(89%) and 2019 (88%). 
Twenty-four units 
achieved completeness 
within three months for 
at least 90% of their 
admissions in 2021, 
compared to twenty-two 
units in 2020. Five units 
had a much lower level 
of data completion in 
2021, all of which were 
below 60%, an increase 
from four units in 2020. 

 
PICANet State of the Nation Report 2022  
 
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Figure 2 shows that there was an increase of just over 40% in the number of children who needed 
an urgent transportation to a PICU in 2021 (n=4,324) compared to 2020 (n=3,073) and similar to 
2019 (n=4,262) prior to the COVID-19 pandemic. 65% of journeys in 2021 began within 30 minutes 
of being requested, a small increase from 2020 (64%) and 2019 (58%). 80% of journeys in 2021 
were started within one hour of the clinical decision being made, compared to 82% and 76% in 
2020 and 2019, respectively. Just over 4% of journeys in 2021 started more than three hours after 
the decision compared to 3% in 2020 and 6% in 2019. 
Metric 3: Emergency readmissions within 48 hours 
Table 5: Emergency readmission within 48 hours of discharge by country of admission, 
2019–2021 
  
2019 
2020 
2021 
2019-2021 
Country of admission 
n 
% 
n 
% 
n 
% 
n 
% 
England 
257 
 1.6 
223 
 1.7 
228 
 1.6 
708 
 1.6 
Wales 
9 
 1.8 
4 
 1.1 
4 
 1.1 
17 
 1.4 
Scotland 
32 
 1.9 
25 
 2.1 
33 
 2.4 
90 
 2.1 
Northern Ireland 
8 
 1.6 
4 
 1.1 
7 
 1.6 
19 
 1.5 
Republic of Ireland 
26 
 1.7 
24 
 1.7 
28 
 1.7 
78 
 1.7 
Total 
332 
 1.6 
280 
 1.7 
300 
 1.6 
912 
 1.7 
 
Figure 3: Relative rate of emergency readmission within 48 hours of discharge by PICU, 
2019–2021 
 
Organisation key 
The percentage of emergency readmissions within 48 hours of discharge remained unchanged in 
2021 across the UK and ROI combined compared to the two preceding years, at 1.6% (Table 5). 
However, this masked some variation at the country level with slightly higher emergency 
readmission rates occurring in Scotland (2.1%) and lower rates seen in Wales (1.4%). There were 
also noticeable differences in emergency readmission rates by unit with this varying between 0.2 to 
1.6 times the overall UK and ROI rate (Figure 3). 
 
 

 
PICANet State of the Nation Report 2022  
 
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Metric 4: Unplanned extubation in PICU 
Table 6: Unplanned extubation rates per 1,000 days of invasive ventilation by country and 
year, 2019–2021 
  
2019 
2020 
2021 
2019-2021 
Country of 
admission 
n 
rate 
n 
rate 
n 
rate 
n 
rate 
England 
249 
4.6 
182 
4.5 
197 
4.1 
628 
4.4 
Wales 
3 
2.7 
4 
6.0 
3 
4.4 
10 
4.0 
Scotland 
25 
6.0 
16 
5.7 
15 
4.4 
56 
5.4 
Northern Ireland 
8 
5.8 
< 3 
< 2.7 
0 
0.0 
9 
2.4 
Republic of Ireland 
23 
4.0 
12 
2.5 
30 
6.0 
65 
4.2 
Total 
308 
4.6 
215 
4.3 
245 
4.2 
768 
4.4 
 
Figure 4: Unplanned extubation rates per 1,000 days of invasive ventilation by health 
organisation, all admissions, 2019-2021 
 
Organisation key 
There was a decline in the overall reported rates of unplanned extubations across the UK and ROI 
from 4.6 per 1,000 days in 2019 to 4.2 per 1,000 days in 2021 (Table 6). Higher rates of unplanned 
extubations were reported in Scotland (5.4 per 1,000 days) and lower rates in Northern Ireland (2.4 
per 1,000 days). Five units reported no unplanned extubation events in 2021 compared to two 
units with a null return in 2020 (Figure 4). Thirteen PICUs demonstrated a decrease in their 
unplanned extubation rate in 2021 compared to 2020, with 10 units reporting an increase in their 
rate (Figure 4). 
 
 
 

 
PICANet State of the Nation Report 2022  
 
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Metric 5: Mortality in PICU 
Figure 5: Risk-adjusted Standardised Mortality Ratio (SMR) by health organisation for under 
16 year olds, 2019–2021 
 
Organisation key 
ZE (Harley Street) will not be flagged as an outlier as the unit closed in 2020 and an investigation previously took place 
Unit X3 (Leicester CICU) was opened in 2021 and therefore has a low number of admissions   
 
There was no evidence that any PICU had an excess mortality rate compared to what would be 
expected based on the level of sickness at the time of admission across the three-year reporting 
period. This is illustrated in Figure 5 based on inclusion of all SMR estimates being contained 
within the control chart limits. Two units (Royal Hospital for Children and Young People PICU, 
Edinburgh and The James Cook University Hospital PCCU, Middlesbrough) had lower mortality 
rates than would be expected and were therefore classified as positive outliers. 
 
www.picanet.org.uk 
xxx@xxx.xx 
University of Leeds 
Richard Feltbower 
Hannah Buckley 
Zoe Cosker 
Kirsten Cromie 
Christopher Leahy 
Hannah Lever 
Lee Norman 
Thomas Simpson 
Laura Stubbs 
University of Leicester 
Elizabeth Draper 
Emily Evans 
Hari Krishnan 
Lyn Palmer 
Martin Perkins 
Sarah Seaton  
 

 
PICANet State of the Nation Report 2022  
 
13 
 
Organisation key  
 
 
A 
Addenbrooke's Hospital, Cambridge 
C 
Noah’s Ark Children’s Hospital for Wales, Cardiff 
D 
Royal Manchester Children’s Hospital 
E1 
Great Ormond Street Hospital, London (PICU/NICU) 
E2 
Great Ormond Street Hospital, London (CICU) 
F 
Evelina London Children’s Hospital 
H 
King’s College Hospital, London 
I 
Leeds General Infirmary 
K2 
Freeman Hospital, Newcastle upon Tyne 
K3 
Great North Children’s Hospital, Newcastle upon Tyne 
L 
Royal Stoke University Hospital 
M 
Nottingham Children’s Hospital, Queens Medical Centre, Nottingham 
N 
John Radcliffe Hospital, Oxford 
O 
Royal Brompton Hospital, London 
P 
Alder Hey Children’s Hospital, Liverpool 
Q 
Sheffield Children’s Hospital 
R 
Southampton Children’s Hospital 
S 
James Cook University Hospital, Middlesbrough 
T 
St George’s Hospital, London 
U 
St Mary’s Hospital, London 
V 
Birmingham Children’s Hospital 
W 
Bristol Royal Hospital for Children 
X1 
Glenfield Hospital, Leicester 
X2 
Leicester Royal Infirmary 
X3 
Leicester Royal Infirmary CICU 
Y 
Royal Hospital for Children and Young People, Edinburgh 
Z 
The Royal London Hospital 
ZA 
Royal Hospital for Children, Glasgow 
ZB 
Royal Belfast Hospital for Sick Children 
ZC 
Children's Health, Ireland, Crumlin formerly Our Lady’s Children’s Hospital, Crumlin, Dublin 
ZD 
Children's Health, Ireland, Temple Street, formerly Temple Street Children’s University Hospital, Dublin 
ZE 
Harley Street Clinic, London 
ZF 
The Portland Hospital, London 
T001 
Children’s Acute Transport Service (CATS) 
T002 
Embrace: Yorkshire & Humber Infant & Children’s Transport Service 
T003 
North West and North Wales Paediatric Transport Service (NWTS) 
T004 
South Thames Retrieval Service (STRS) 
T005 
KIDS Intensive Care and Decision Support 
T008 
Southampton Oxford Retrieval Team (SORT) 
T010 
Northern Ireland Specialist Transport and Retrieval (NISTAR) Paediatric 
T020 
Scotland Specialist Transport and Retrieval (ScotSTAR) 
T022 
Irish Paediatric Acute Transport Service (IPATS) 
T024 
Wales and West Acute Transport for Children (WATCh) 
T026 
North East Children’s Transport and Retrieval Service (NECTAR) 
T027 
Children’s Medical Emergency Transport Service (CoMET) 
T028 
Heart Link ECMO Children's Service (Inc. in Tables & Figures only) 
T032 
Paediatric and Neonatal Decision Support and Retrieval Service (PaNDR)