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 paediatric 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 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."
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."
The study was funded by the National Institute for Health Research.
Notes to editors:
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.
To request interviews with Dr Duncan Macrae, please contact Mark Fenwick, Head of Media Relations, Royal Brompton & Harefield NHS Foundation Trust on +44 (0)207 351 8672 or m.fenwick@rbht.nhs.uk
To request interviews with Dr Richard Grieve, please contact the London School of Hygiene & Tropical Medicine press office on +44 (0)207 927 2802 or press@lshtm.ac.uk
- An embargoed copy of the article which will appear in the New England Journal of Medicine is available on request from m.fenwick@rbht.nhs.uk
- The potential £12 million saving to the NHS is calculated because the CHiP trial is a UK study, with costs originally calculated in UK pounds and then converted into US dollars purchasing power parities (PPP), which allow for currency fluctuations over time.
- Royal Brompton & Harefield NHS Foundation Trust is a national and international specialist heart and lung centre based in Chelsea, London and Harefield, Middlesex. The Trust helps patients from all age groups who have heart and lung problems and is the country's largest centre for the treatment of adult congenital heart disease. http://www.rbht.nhs.uk
- The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,500 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as one of the world's top universities for collaborative research. The School's mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk
Journal
New England Journal of Medicine