London School of Hygiene & Tropical Medicine

A major UK-wide study 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 paediatric intensive care units (PICU) commonly control blood sugar levels for some patients, according to a new study published in the New England Journal of Medicine.

During the stress of severe illness or major surgery, blood glucose levels often rise to high levels, resulting in so-called 'stress hyperglycaemia'. The CHiP trial, led by Royal Brompton & Harefield NHS Foundation Trust  and the London School of Hygiene & Tropical Medicine, included 1,369 children at 13 children's intensive care units across the country.

Researchers compared the effects of allowing a 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 study findings 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 Grieve said: "For children admitted to paediatric 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 paediatric 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."

Lead author Dr Duncan Macrae, a consultant in children's intensive care at Royal Brompton & Harefield NHS Foundation Trust, added: "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.

The study was funded by the National Institute for Health Research.

Publication

• 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.DOI: 10.1056/NEJMoa1302564.

* The potential £12 million saving to the NHS was originally calculated in UK pounds and then converted into US dollars for the journal publication using purchasing power parities (PPP), which allow for currency fluctuations over time.