A major UK-wide study (The CHiP trial) led by Royal Brompton & Harefield NHS Foundation Trust in partnership with the London School of Hygiene & Tropical Medicine, has found that the NHS could reduce the length of hospital stay for critically ill children and save around £12 million a year, by changing the way pediatric intensive care units (PICU) commonly control blood sugar levels for some patients.
During the stress of severe illness or major surgery, blood glucose levels often rise to high levels, resulting in so-called 'stress hyperglycaemia'. The research trial, which included 1,369 children at 13 children's intensive care units across the country, compared the effects of allowing this natural rise in blood glucose to occur (conventional or 'usual' management) to the effects of controlling the rise using insulin to maintain normal glucose levels (tight glycaemic control).
The findings of the study, which are published today in the New England Journal of Medicine, show that there was a remarkable difference between the two treatment groups during one-year follow-up.
Among those children studied in intensive care who had not undergone heart surgery, tight glycaemic control resulted in an average length of hospital stay 13.5 days less that those children receiving 'usual care', in whom glucose levels were allowed to rise naturally. No such benefits were seen for children who had undergone heart surgery.
Study co-author, Dr Richard Grieve, Reader in Health Economics at the London School of Hygiene & Tropical Medicine, calculated that implementation of tight glycaemic control for similar children admitted to all PICUs in England and Wales, could save the NHS about £12 million each year.
Dr Duncan Macrae, a consultant in children's intensive care at Royal Brompton & Harefield NHS Foundation Trust, explained: "The findings of our study have important implications for the way blood glucose levels are managed in very sick children. Although we do not fully understand why controlling blood glucose levels during a child's most critical days leads to a quicker recovery, evidence from this study suggests that doctors caring for very sick children, who have not undergone heart surgery, should consider controlling blood glucose levels more closely during intensive care.
Dr Grieve of the London School of Hygiene & Tropical Medicine, noted: "For children admitted to pediatric intensive care who have not had heart surgery, a policy of tight glycemic control could reduce costs by about £10,000 per child. With around 1,200 children admitted to pediatric intensive care units in England and Wales who meet these criteria, this policy could save the NHS up to £12 million each year.
"While careful consideration should be given to the small increased risk in hypoglycaemia (low blood sugar), the potential benefits for children in going home sooner, and the release of hospital beds for other severely ill patients, would be significant."
Dr Macrae added: "The study also brings into focus the importance of collaborative research, as no one children's intensive care unit could have undertaken a study of such size, and I am grateful to all colleagues, children and their families who supported the study."
- Duncan Macrae, Richard Grieve, Elizabeth Allen, Zia Sadique, Kevin Morris, John Pappachan, Roger Parslow, Robert C. Tasker, Diana Elbourne. A Randomized Trial of Hyperglycemic Control in Pediatric Intensive Care. New England Journal of Medicine, 2014; 370 (2): 107 DOI: 10.1056/NEJMoa1302564
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