Summary Report
Source: data.gov.uk (2025-12-19)

PICANet Annual Report 2022-2024. Paediatric Intensive Care Audit - This data contains information on all admissions to Paediatric Intensive Care units in the UK and Ireland 2022-2024

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PICANet State of the Nations Report 2025 
 
 
 
 2  
 
Contents 
Introduction ................................................................................................................................................ 3 
Key Messages ........................................................................................................................................... 3 
National Recommendations ....................................................................................................................... 4 
Characteristics of children admitted to paediatric intensive care units ........................................................ 5 
Mortality within paediatric intensive care units ........................................................................................... 7 
Key Metrics ................................................................................................................................................ 8 
Metric 1: Case ascertainment and timeliness of data submission for 2024 ............................................ 8 
Metric 2: Transport team mobilisation times .......................................................................................... 9 
Metric 3: Emergency readmissions within 48 hours ............................................................................. 10 
Metric 4: Unplanned extubations in PICU ............................................................................................ 11 
Metric 5: Risk adjusted in–PICU mortality............................................................................................ 12 
Organisation Key ..................................................................................................................................... 13 
 
 
 
The National Paediatric Critical Care Audit is commissioned by the Healthcare Quality Improvement Partnership   
(HQIP) and funded by NHS England as part of the National Clinical Audit and Patient Outcomes Programme. Funding 
for participation also comes from the NHS Wales Joint Commissioning Committee, NHS Lothian and 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. 
 
 
 
 
 
 
 
 
 
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: xxx@xxx.xx or Tel: 
xx-xxxx-xxxx  
 
Citation for this report: Paediatric Intensive Care Audit Network (PICANet) National Paediatric Critical Care Audit State of the 
Nations Report 2025. Universities of Leeds and Leicester, 2025.  
© 2025 Healthcare Quality Improvement Partnership (HQIP) 
ISBN: 978-0-85316-370-1 
 
 
Report resources  
We have a range of resources to accompany this report online.  
➢ An Infographic for a quick view of the report’s key findings.  
➢ Interactive charts with their underlying data to explore topic areas and in-depth mortality and data 
quality tables charts.   
➢ The Appendices contain background information and methodology about the audit.  
➢ Organisation Key 
➢ New this year, we look back at how the key metric results have changed over time.  
We provide a range of Quality Improvement Resources for participating organisations and the PICANet 
Data Dashboard is refreshed and updated monthly. 

PICANet State of the Nations Report 2025 
 
 
 
 3  
 
Introduction 
 
The State of the Nations Report 2025 represents the 22nd PICANet annual clinical audit report summarising 
paediatric critical care activity within designated Level 3 paediatric intensive care units (PICU) and 
Paediatric Critical Care Transport Services in the United Kingdom (UK) and Republic of Ireland (ROI) 
between 2022 and 2024.  
The report describes key metrics and outcomes related to transport and admission events in order to 
monitor the delivery and quality of care against agreed standards and evaluate clinical outcomes to inform 
national policy in paediatric critical care. 
The report presents three national recommendations that highlight the evolving landscape of paediatric 
critical care, shifting from treating children with acute, short-term sickness to supporting a growing number 
living with lifelong conditions.  
 
Professor Richard G. Feltbower 
Associate Professor Sarah E. Seaton 
PICANet Principal Investigators 
 
Key Messages 
 
 
 
 
  
. 
 
 
This report was prepared by members of the PICANet project team:  
 
Evrim Anik 
Hannah Buckley 
Emily Evans 
Hari Krishnan 
Christopher Leahy 
Hannah Lever 
Lisa Mcllmurray 
 
 
Lee Norman 
Lyn Palmer 
Martin Perkins 
Rachel Shorthose 
Thomas Simpson 
Laura Stubbs 
Georgina Tayler-Barrett 
 
With support from the PICANet Steering Group and Clinical Advisory Group 
 Characteristics of children admitted to PICU 
• 
There were 18,021 admissions to paediatric intensive care units (PICUs) in 2024; 
around 50 per day. 
• 
The total number of bed days of care delivered in PICU declined from 145,294 in 2022 
to 141,060 in 2024. 
• 
The percentage of admissions from ethnic minorities (children of Asian, Black, Mixed or 
Other ethnicity) increased from 26.4% in 2022 to 29.7% in 2024. Children from ethnic 
minorities continue to be over-represented in PICU relative to the general population, 
with admission rates per 100,000 population for Asian and Black children at 162.0 and 
170.5 respectively, compared to 124.6 overall. 
• 
The percentage of admissions which recorded ethnicity as “unknown/not stated” 
increased from 9.5% in 2023 to 11.0% in 2024. This comes after a decline in missing 
data in the years prior to this annual reporting period.  
• 
Children living in the highest areas of deprivation were more likely to be admitted to a 
PICU than children from the least deprived areas. 
 Characteristics of children admitted to PICU 
• 
The most common primary diagnosis group and reason for admission continues to be 
Respiratory conditions, accounting for 29.9% of all admissions across the 2022-2024 
reporting period. However, this percentage has declined over time, falling to 28.5% in 
2024, from 30.9% in 2022 and 30.2% in 2023. 
• 
The percentage of admissions for cardiovascular conditions increased from 24.5% in 
2022 to 27.4% in 2024. 

PICANet State of the Nations Report 2025 
 
 
 
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National Recommendations 
 
New recommendations for this year  
 
 
 
 
 
Recommendation extended from last year  
 
 
 
1. Develop a clear and measurable definition of children with medical complexity that can be 
consistently identified using routine data sources. 
Action: Paediatric Critical Care Society special interest group, National Institute for Health and Care 
Research 
Why this recommendation? This group of children are increasing in number but as yet we have no 
clear definition which we can use to audit the care provided to them compared to other groups.  
3. Continue to monitor reasons for admission to PICU and assess how changes to the respiratory 
syncytial virus (RSV) vaccination programme affect paediatric critical care services. 
Action: UK Health Security Agency (UKHSA), National Institute for Health and Care Research, 
Paediatric Critical Care Society Study Group 
Why this recommendation? The maternal RSV vaccination programme is expected to have its full 
impact on infant critical care admissions in the 2025-26 season, after launching close to the beginning 
of the 2024-25 season. Additionally, NHS England announced in July 2025 that the nirsevimab 
immunisation will be rolled out to high-risk babies and very preterm infants, potentially impacting on 
respiratory admissions. We have observed a small decline in the percentage of admissions due to 
respiratory reasons in recent years which should be explored more into the future.   
2. Review the place of death for children who die in PICU to assess whether it was the most 
appropriate setting for the child and their family/carers. 
Action: National Child Mortality Database and equivalent bodies in other nations  
Why this recommendation? As mortality rates have reduced over time, and in more recent years 
have plateaued, it is important to consider the appropriate place that children who die should be cared 
for in the end stages of their life. 
Key metrics 
• 
Case ascertainment in 2024 was estimated to be 100%. 
• 
In 2024, 81.8% of all PICU admission records were submitted to PICANet within two 
months. 78.3% of all transport events records were submitted within two months. 
• 
Fewer non-elective transport events occurred in 2024 (4,059) compared to 2023 (4,188) 
and 2022 (4,552). 
• 
In 2024, 68.7% of known transport journeys were started within 30 minutes of a clinical 
decision whereas 3.3% of the journeys were started more than 3 hours after a clinical 
decision. 
• 
The percentage of emergency readmissions within 48 hours of discharge remained 
steady at 1.6% throughout the reporting period.   
• 
Unplanned extubation rates declined from 4.6 per 1,000 days of ventilation in 2022 and 
2023, to 4.2 in 2024. 
• 
In 2024, 3.8% of children admitted to PICUs did not survive and this has remained 
relatively consistent over the last three years. 
• 
No units were identified as a statistical outlier for mortality, i.e. having a higher or lower 
mortality rate than we would have expected given the children they cared for. 

PICANet State of the Nations Report 2025 
 
 
 
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Characteristics of children admitted to paediatric intensive care units 
Table 1a: Admissions to PICU across the UK & Republic of Ireland by socio-demographic characteristics and year of admission.  
  
Year 
  
2022 
n (%) 
2023 
n (%) 
2024 
n (%) 
2022-2024 
n (%) 
Total 
18,532 (33.7%) 
18,509 (33.6%) 
18,021 (32.7%) 
55,062 (100.0%) 
Sex 
  Male 
10,509 (56.7%) 
10,371 (56.0%) 
10,178 (56.5%) 
31,058 (56.4%) 
  Female 
8,023 (43.3%) 
8,138 (44.0%) 
7,843 (43.5%) 
24,004 (43.6%) 
Age group 
(years) 
  <1 year 
7,751 (41.8%) 
7,554 (40.8%) 
7,350 (40.8%) 
22,655 (41.1%) 
  1-4 years 
4,589 (24.8%) 
4,662 (25.2%) 
4,289 (23.8%) 
13,540 (24.6%) 
  5-10 years 
3,088 (16.7%) 
3,193 (17.3%) 
3,162 (17.5%) 
9,443 (17.1%) 
  11-15 years 
3,104 (16.7%) 
3,100 (16.7%) 
3,220 (17.9%) 
9,424 (17.1%) 
Ethnicity 
  Asian 
2,187 (11.8%) 
2,298 (12.4%) 
2,437 (13.5%) 
6,922 (12.6%) 
  Black 
1,004 (5.4%) 
1,102 (6.0%) 
1,212 (6.7%) 
3,318 (6.0%) 
  Mixed 
685 (3.7%) 
688 (3.7%) 
729 (4.0%) 
2,102 (3.8%) 
  White 
11,517 (62.1%) 
11,492 (62.1%) 
10,663 (59.2%) 
33,672 (61.2%) 
  Other 
1,028 (5.5%) 
1,164 (6.3%) 
995 (5.5%) 
3,187 (5.8%) 
  Unknown/not stated 
2,111 (11.4%) 
1,765 (9.5%) 
1,985 (11.0%) 
5,861 (10.6%) 
Deprivation 
1 (most deprived) 
4,797 (30.0%) 
4,639 (29.0%) 
4,590 (29.6%) 
14,026 (29.5%) 
2 
3,569 (22.3%) 
3,711 (23.2%) 
3,408 (22.0%) 
10,687 (22.5%) 
3 
2,948 (18.5%) 
2,746 (17.2%) 
2,838 (18.3%) 
8,530 (18.0%) 
4 
2,498 (15.6%) 
2,417 (15.1%) 
2,395 (15.4%) 
7,310 (15.4%) 
5 (least deprived) 
2,108 (13.2%) 
2,339 (14.6%) 
2,162 (13.9%) 
6,609 (13.9%) 
Missing 
51 (0.3%) 
132 (0.8%) 
123 (0.8%) 
306 (0.6%) 
Country 
  England (NHS) 
14,287 (77.1%) 
14,264 (77.1%) 
13,891 (77.1%) 
42,442 (77.1%) 
  England (non-NHS) 
279 (1.5%) 
255 (1.4%) 
228 (1.3%) 
762 (1.4%) 
  Wales 
397 (2.1%) 
403 (2.2%) 
426 (2.4%) 
1,226 (2.2%) 
  Scotland 
1,509 (8.1%) 
1,500 (8.1%) 
1,434 (8.0%) 
4,443 (8.1%) 
  Northern Ireland 
425 (2.3%) 
395 (2.1%) 
349 (1.9%) 
1,169 (2.1%) 
  Republic of Ireland 
1,635 (8.8%) 
1,692 (9.1%) 
1,693 (9.4%) 
5,020 (9.1%) 
 
Percentages are calculated within category by column, except for the total row. Deprivation scores were calculated for residents of England, Wales and Scotland admitted to a PICU in those 
nations. Deprivation score was based on the location of residence of the child using 2021 Townsend scores. Deprivation categories are equivalised to contain equal populations. Where a child’s 

PICANet State of the Nations Report 2025 
 
 
 
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address was unknown these were added to the ‘Missing’ row. Ethnicity categories were defined using Office for National Statistics 
definitions (Ethnic group, national identity, and religion). ‘Country’ refers to the location of the PICU at admission rather than 
residence of the child.  
 
Total paediatric intensive care unit (PICU) admissions decreased in 2024 (18,021) compared to 2023 
(18,509) and 2022 (18,532) (Table 1a). This reduction corresponds with a reduction in bed days, from 
145,294 in 2022 to 141,060 in 2024, representing the number of days of care delivered in PICU. The 
reduction in admissions occurred in England, Scotland and Northern Ireland, although increased slightly in 
Wales and the ROI.  
 
There were more male admissions (56.4%) to PICU than female (43.6%) overall, although in 2023 the 
proportion of male admissions decreased slightly to 56.0%. 41.1% of all admissions were for children under 
one year of age. There was a slight increase in the proportion of admissions within the two oldest age 
categories, from 33.4% in 2022 to 35.4% in 2024, and a corresponding reduction in the two youngest age 
categories. This may represent an increase of admissions from children living with medical complexity or 
lifelong conditions who are growing older or may partly reflect changes in the population distribution. 
However, this is not possible to quantify as currently there is no agreed definition for this group of children. 
More than twice as many admissions came from the most deprived group compared to the least deprived.  
 
The percentage of admissions recorded as White ethnicity fell to 59.2% in 2024 compared to 62.1% 
between 2022 and 2023 (Table 1a). The percentage of admissions from Asian, Black and Mixed ethnicities 
all increased across the three years. The percentage of admissions recorded as ‘Other’ ethnicity declined in 
2024 compared to 2023 (from 6.3% to 5.5%), whereas the percentage of admissions with an unknown 
ethnicity rose in 2024 to 11.0% from 9.5% in the previous year. This reverses a long-term trend of reducing 
percentages of ‘Unknown’ ethnicity being recorded.  
 
Table 1b: Admission rate per 100,000 population by ethnicity (England only) 
 
 
 
 
 
 
 
Admission rate is calculated per 100,000 population per year. Admissions are the mean average for the three-year reporting period 
and exclude admissions that had ethnicity recorded as ‘unknown’ or ‘not stated’. The child population estimates within each ethnic 
group were calculated using data from the 2021 census. 
Table 1b shows that 61.1% of admissions to PICU in England were for children of White ethnic origin, 
compared to 72.4% in the general childhood population. The admission rate for White 
ethnic group was 105.0 per 100,000 population per year. This remains substantively lower than the Black 
and Asian admission rates of 170.5 and 162.0 per 100,000 population respectively.  
 
Ethnicity 
Admission 
rate 
Average annual admissions 
2022-2024 n (%) 
Child population 
2021 n (%) 
Asian 
162.0 
2093 (16.0) 
1,291,980 (12.3) 
Black 
170.5 
1,005 (7.7) 
589,435 (5.6) 
Mixed 
135.9 
994 (7.6) 
731,180 (7.0) 
White 
105.0 
7,973 (61.1) 
7,591,975 (72.4) 
Other 
356.9 
994 (7.6) 
278,505 (2.7) 
Total 
124.6 
13,059 
10,483,075 

PICANet State of the Nations Report 2025 
 
 
 
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Table 2: Total admissions by primary diagnostic group and year of admission 
Primary diagnosis 
2022 
n (%) 
2023 
n (%) 
2024 
n (%) 
2022-2024 
n (%) 
Respiratory 
5,732 (30.9) 5,590 (30.2) 
5,135 (28.5) 
16,457 (29.9) 
Cardiovascular 
4,549 (24.5) 4,843 (26.2) 
4,938 (27.4) 
14,330 (26.0) 
Neurological 
2,177 (11.7) 2,248 (12.1) 
2,158 (12.0) 
6,583 (12.0) 
Other 
1,590 (8.6) 
1,611 (8.7) 
1,611 (8.9) 
4,812 (8.7) 
Gastrointestinal 
1,103 (6.0) 
1,119 (6.0) 
1,020 (5.7) 
3,242 (5.9) 
Infection 
994 (5.4) 
896 (4.8) 
782 (4.3) 
2,672 (4.9) 
Musculoskeletal 
792 (4.3) 
792 (4.3) 
753 (4.2) 
2,337 (4.2) 
Endocrine/metabolic 
773 (4.2) 
639 (3.5) 
597 (3.3) 
2,009 (3.6) 
Oncology 
716 (3.9) 
656 (3.5) 
564 (3.1) 
1,936 (3.5) 
Unknown 
106 (0.6) 
115 (0.6) 
463 (2.6) 
684 (1.2) 
 
Diagnosis groups represented by ‘Other’ were: Blood/lymphatic, Body wall and cavities, Trauma, Multisystem, and Other. 
The most common reason for admission to PICU across the 2022-2024 reporting period was a respiratory 
diagnosis (29.9%), followed by a cardiovascular condition (26.0%) (Table 2). The percentage of respiratory 
admissions has declined over time, falling to 28.5% in 2024 from 30.9% in 2022. The percentage of 
admissions for cardiovascular conditions increased from 24.5% in 2022 to 27.4% in 2024.The percentage of 
admissions with an Endocrine/metabolic primary diagnosis declined from 4.2% to 3.3% between 2022 and 
2024, whilst those with an Oncology primary diagnosis declined from 3.9% to 3.1% over the same period 
(Table 2). 
 
 
Mortality within paediatric intensive care units 
Table 3a: Percentage of deaths in PICU of all admissions, by country and year of admission  
Country of admission 
2022 
n (%) 
2023 
n (%) 
2024 
n (%) 
2022-2024 
n (%) 
England 
609 (4.2) 
582 (4.0) 
569 (4.0) 
1,760 (4.1) 
Wales 
14 (3.5) 
12 (3.0) 
14 (3.3) 
40 (3.3) 
Scotland 
32 (2.1) 
41 (2.7) 
39 (2.7) 
112 (2.5) 
Northern Ireland 
17 (4.0) 
8 (2.0) 
11 (3.2) 
36 (3.1) 
Republic of Ireland 
55 (3.4) 
44 (2.6) 
56 (3.3) 
155 (3.1) 
Total 
727 (3.9) 
687 (3.7) 
689 (3.8) 
2,103 (3.8) 
 
Overall, 96.2% of all admissions to PICU were discharged alive (Table 3a). The percentage of deaths in 
PICU was 3.8% in 2024 which remained steady over the three-year period. Mortality in England was the 
highest of all nations (4.1%). In the other four nations, mortality ranged from 2.5% (Scotland) to 3.3% 
(Wales). 
 
Table 3b: Percentage of deaths in PICUs of all children’s deaths in the population: UK and Republic 
of Ireland 
Country of 
admission 
2022 
2023 
2024 
2022-2024 
England and Wales 
17.8% (n=623) 
16.2% (n=594) 
16.0% (n=583) 
16.7% (n=1,800) 
Scotland 
13.2% (n=32) 
14.6% (n=41) 
15.9% (n=39) 
14.6% (n=112) 
Northern Ireland 
14.4% (n=17) 
9.2% (n=8) 
12.8% (n=11) 
12.4% (n=36) 
Republic of Ireland 
19.2% (n=55) 
18.1% (n=44) 
20.0% (n=56) 
19.2% (n=155) 
Total 
17.6% (n=727) 
16.1% (n=687) 
16.2% (n=689) 
16.6% (n=2,103)  
 

PICANet State of the Nations Report 2025 
 
 
 
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In England and Wales, 16.7% of all childhood deaths occurred within a PICU (Table 3b). This percentage 
decreased between 2022 and 2024. In Scotland, Northern Ireland and the ROI, the overall percentage of 
childhood deaths occurring within PICU was 14.6%, 12.4% and 19.2% respectively (Table 3b).  
 
Key Metrics 
Metric 1: Case ascertainment and timeliness of data submission for 2024 
Case ascertainment checks were conducted at all PICUs on four occasions in 2024. Each covered a period 
of two out of three months within a quarter thus the case ascertainment metric covers eight out of the twelve 
months in 2024. Units were given the opportunity to resolve initial discrepancies identified on the PICANet 
database. In 2024, case ascertainment for all units was 100%. 
 
A similar process was undertaken and reported for the first time for the 13 Transport Organisations. In 2024, 
case ascertainment for these organisations was also 100%. 
 
Figure 1a: Percentage of admission records completed within two months of discharge from PICU, 
2024  
 
Organisation Key 
 
 

PICANet State of the Nations Report 2025 
 
 
 
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The overall percentage of PICU admissions completed within two months of discharge in 2024 was 81.8% 
(Figure 1a). 20 units (out of 31 in total) performed better than this overall figure, with four units achieving 
100% complete records within two months. Of the 11 units performing below the overall figure, three had 
fewer than 50% of their records completed within two months of the child’s discharge (Figure 1a). 
 
Figure 1b: Percentage of transport records completed within two months after the transfer, 2024 
 
Organisation Key 
 
This is the first time we have reported timeliness for the transport teams, with over three quarters of 
transport events (78.3%) completed within the two-month target (Figure 1b). Whilst 10 of the 13 teams 
performed above this overall figure (including one Team with 100% of records completed within two 
months), one transport team did not complete any of its records within the two-month target1.   
 
Metric 2: Transport team mobilisation times 
 
Figure 2: Number of non-elective transports to PICU by time to mobilisation and year: UK and 
Republic of Ireland  
 
These figures exclude transports where base unit collection time was not applicable (47 in 2022, 46 in 2023, and 31 in 2024) or 
missing (27 in 2022, 10 in 2023, and 12 in 2024). 
 
1 This was due to clinical and administrative staffing vacancies and turnover 
3006
2802
2768
700
627
639
582
525
476
190
178
133
0%
20%
40%
60%
80%
2022
2023
2024
Percentage of transports
≤30 mins
≥31 & ≤ 60 mins
≥61 & ≤180 mins
≥ 181 mins

PICANet State of the Nations Report 2025 
 
 
 
 10  
 
The total number of non-elective transports undertaken by a paediatric critical care transport team to a PICU 
was 4,059 in 2024, lower than those undertaken in 2022 (4,552) and 2023 (4,188). In 2024, excluding those 
where base unit collection time was not applicable, 99.7% of all transports had a known mobilisation time 
and 68.7% of these (Figure 2) began within 30 minutes of the clinical decision being made. This is an 
improvement on 2022 and 2023, where the percentage of known mobilisation times under 30 minutes was 
66.7% and 67.6% respectively. The percentage of non-elective transports mobilising in over three hours has 
improved over the three years, from 4.2% and 4.3% in 2022 and 2023 respectively, to 3.3% in 2024. 
 
Metric 3: Emergency readmissions within 48 hours 
 
Table 4: Emergency readmission within 48 hours of discharge by country of admission2  
Country of admission 
2022 
n (%) 
2023 
n (%) 
2024 
n (%) 
2022-2024 
n (%) 
England 
219 (1.5) 
227 (1.6) 
224 (1.6) 
670 (1.6) 
Wales 
5 (1.3) 
8 (2.0) 
11 (2.6) 
24 (2.0) 
Scotland 
31 (2.1) 
31 (2.1) 
29 (2.0) 
91 (2.0) 
Northern Ireland 
3 (0.7) 
4 (1.0) 
2 (0.6) 
9 (0.8) 
Republic of Ireland 
25 (1.5) 
31 (1.8) 
26 (1.5) 
82 (1.6) 
Total 
283 (1.5) 
301 (1.6) 
292 (1.6) 
876 (1.6) 
 
In 2024, emergency readmissions within 48 hours of discharge to the same PICU were 1.6% of all 
admissions, and represented a similar percentage compared to 2023 (1.6%) and 2022 (1.5%) (Table 4). In 
2024 the percentage of emergency readmissions was highest in Scotland and Wales, similar to 2023. The 
proportion in Northern Ireland was consistently lower than other nations. 
 
Figure 3: Relative rate of emergency readmission within 48 hours of discharge by PICU, 2022-2024 
 
Organisation Key 
  
 
Figure 3 shows the relative rate of emergency readmissions by unit, which is calculated as the rate for each 
unit divided by the overall rate of 1.59. The relative rate of emergency readmissions ranged from 0.36 
(lowest) to 1.57 (highest). 
 
2 Emergency readmissions are not adjusted for case-mix due to small numbers of events preventing meaningful 
adjustment. 

PICANet State of the Nations Report 2025 
 
 
 
 11  
 
Metric 4: Unplanned extubations in PICU 
 
Table 5: Unplanned extubation rates per 1,000 days of invasive ventilation by country and year 
Country of 
admission 
2022 
2023 
2024 
2022-2024 
n 
rate 
n 
rate 
n 
rate 
n 
rate 
England 
241 
4.3 
225 
4.2 
202 
3.8 
668 
4.1 
Wales 
2 
1.8 
6 
3.9 
14 
11.2 
22 
5.7 
Scotland 
26 
7.1 
23 
7.0 
17 
4.4 
66 
6.1 
Northern Ireland 
9 
7.0 
4 
4.1 
2 
2.4 
15 
4.8 
Republic of Ireland 
33 
6.6 
38 
6.5 
32 
6.3 
103 
6.5 
Total 
311 
4.6 
296 
4.6 
267 
4.2 
874 
4.5 
 
The overall three-year rate of unplanned extubation was 4.5 per 1,000 days of invasive ventilation (Table 5). 
In 2024 this was 4.2 which was a reduction from 4.6 in 2022 and 2023. In all three years, this was below the 
standard of five per 1,000. Reductions in unplanned extubation rates over time were seen across all nations 
except for Wales where rates increased from 1.8 to 11.2 in 2024, albeit based on low numbers as shown in 
Table 5.  
 
Figure 4: Unplanned extubation rates per 1,000 days of invasive ventilation by PICU, 2022-2024  
 
Organisation Key 
 
Figure 4 shows that in 2024, 22 out of 31 units (70.0%) met the NHS England target (PIC08a) of a rate of 
unplanned extubations below 5.0 per 1,000 invasive ventilation days. 
 
 

PICANet State of the Nations Report 2025 
 
 
 
 12  
 
Metric 5: Risk adjusted in–PICU mortality 
 
Figure 5: Risk adjusted Standardised Mortality Ratio (SMR) by health organisation, 2022 – 2024 
 
Key  
            SMR = 1 (expected deaths are equal to observed deaths)  
99.9% control limits3 
Organisation Key 
 
No units were identified as having a higher or lower mortality rate than we would have expected given the 
children admitted to PICU over the three-year reporting period, so none were classified as “statistical 
outliers”. This can be seen in Figure 5, where none of the unit-specific SMR estimates were above the upper 
control limit or below the lower control limit. 
 
 
 
 
 
 
 
 
 
 
3 For more information please see the PICANet Outlier Policy. 

PICANet State of the Nations Report 2025 
 
 
 
 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) 
E2 
E3 
Great Ormond Street Hospital, London (CICU) 
Great Ormond Street Hospital, London (NICU) 
F1 
F2 
Evelina London Children’s Hospital (previously F) 
Royal Brompton Hospital, London (previously O) 
H 
King’s College Hospital, London 
I 
Leeds Children’s Hospital 
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 
P 
Alder Hey Children’s Hospital, Liverpool 
Q 
Sheffield Children’s Hospital 
R 
Southampton Children’s Hospital 
T 
St George’s Hospital, London 
U 
St Mary’s Hospital, London 
V 
Birmingham Children’s Hospital 
W 
Bristol Royal Hospital for Children 
X2 
Leicester Royal Infirmary CICU 
X3X1 
Leicester Royal Infirmary CPICU (previously known as Glenfield Hospital, Leicester) 
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 
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 
Scottish 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 (included in the SoN Tables only) 
T032 
 
Paediatric and Neonatal Decision Support and Retrieval Service (PaNDR) 
 
Celebrating 22 years of data  
Thank you to all of the PICU and transport teams for making this possible