There is no worldwide agreement on one definition of Acute Paediatric Critical Illness— even though it is generally understood to be a serious disease process that can lead to death. The lack of consensus has made it difficult to pin down the number of children who develop this life-threatening condition.
But now a group of more than 100 international experts from 40 countries have arrived at a consensus. Associate Professor Dr Qalab Abbas from the Department of Paediatrics & Child Health at Aga Khan University is a member of the group and a co-author for the findings published as 'A research definition and framework for acute paediatric critical illness across resource-variable settings: a modified Delphi consensus' in The Lancet Global Health on January 5, 2024.
The final consensus on the definition of acute paediatric critical illness emerged as: an infant, child, or adolescent with an illness, injury, or post-operative state that increases the risk for or results in acute physiological instability (abnormal physiological parameters or vital organ dysfunction or failure) or a clinical support requirement (such as frequent or continuous monitoring or time-sensitive interventions) to prevent further deterioration or death.
So far, acute paediatric critical illness has been defined by location of care or if the child is admitted to an ICU. This is, however, a limited definition as such children can come to be seen in multiple places such as community clinics, field hospitals, emergency rooms. In hospitals with limited resources, critically ill children are not always sent to the ICU.
“Low- and middle-income countries in general, and Pakistan specifically, lack evidence (research) to manage critically ill children, which is why we are bound to copy what the developed world or Global North tells us," said Dr Qalab Abbas. “We do this even though our population and diseases are different. So we wanted to have local evidence to treat our population and diseases, and also wanted to develop a definition which was universal."
The definition was developed after 29 studies were reviewed, and key concepts were identified by an interdisciplinary, international panel of 24 experts. Then a panel of 109 experts reached agreement on eight essential attributes and 28 statements on acute paediatric critical illness.
The initiative was taken by the Paediatric Acute Lung Injury and Sepsis Investigators Global Health Subgroup, which is dedicated to studying the burden of acute paediatric critical illness globally.
In addition to Dr Qalab Abbas, Pakistan was represented by Dr Muhammad Ali of Paediatric Oncology at the Pakistan Institute of Medical Sciences, Islamabad, and Dr Muhammad Irfan Habib of Clinical Affairs at ChildLife Foundation, Karachi.
