Global PARITY: Study Design for a Multi-Centered, International Point Prevalence Study to Estimate the Burden of Pediatric Acute Critical Illness in Resource-Limited Settings

Abstract

BackgroundThe burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally.MethodsWe will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites.DiscussionThis study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes.

Development and pilot testing of PROACTIVE: A pediatric onco‐critical care capacity and quality assessment tool for resource‐limited settings

“…Recently, our team used an expert consensus process to identify POCC capacity and quality indicators to create PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE) 17 ; a tool to evaluate POCC services in resource‐limited hospitals, defined as hospital with a broad range of self‐identified resource limitations including personnel, medications, equipment, and material supplies 18 needed to treat children with cancer.…”

“…critical care medicine, global health, health quality of care, pediatric cancer, quality improvement including personnel, medications, equipment, and material supplies 18 needed to treat children with cancer.…”

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico

“…While the true burden of acute critical illness is unknown, previous point prevalence studies focusing on specific diseases suggest that at least 80% of the 64 million annual deaths in children take place in LMICs, where lack of resources can negatively impact the outcomes for acute critical illness ( 5 , 6 ) and oncological disease ( 7 ). In High-income countries (HICs), children with cancer have a higher risk for adverse outcomes than general pediatric patients during critical illness, with mortality ranging from 6.8-27% ( 4 ), representing mortality almost three times higher than that of previously healthy children with critical illness ( 8 ).…”

Diagnostic, Management, and Research Considerations for Pediatric Acute Respiratory Distress Syndrome in Resource-Limited Settings: From the Second Pediatric Acute Lung Injury Consensus Conference

“…To address these constraints, the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) initiative introduced a new subsection to focus on PARDS recommendations that are pertinent to practitioners and researchers working in RLS. For the purpose of this review, we defined RLS in line with other studies as hospitals with a range of resource limitations, including being situated in a country classified as low-or middle-income by the world bank or having limited access to or availability of critical care including medications, equipment, and/or healthcare personnel (15)(16)(17). This article, therefore, addressed key question number 11 as outlined in the accompanying Methods article (18): How should the recommendations for the diagnosis and management of PARDS be adapted to the context of RLS?…”