Bhaskar Priya, Rettiganti Mallikarjuna, Gossett Jeffrey M, Gupta Punkaj
Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas, USA.
Ann Pediatr Cardiol. 2018 Jan-Apr;11(1):48-55. doi: 10.4103/apc.APC_99_17.
The existing training pathways to become a pediatric cardiac intensivist are very variable with physicians coming from varied training backgrounds of pediatric critical care, pediatric cardiology, neonatology, or pediatric anesthesia.
To evaluate the impact of cardiac Intensive Care Unit (ICU) attending physician training background on outcomes in children undergoing heart operations.
Patients in the age group from 1 day to 18 years undergoing heart operation at a Pediatric Health Information System database participating hospital were included (2010-2015).
Based on the training background of majority of attending physicians in an ICU, the participating ICUs were divided into three groups: critical care medicine (CCM), cardiology, and indeterminate.
Multivariable logistic regression models were fitted to evaluate the association of ICU physician training background with study outcomes.
A total of 54,935 patients from 42 ICUs were included. Of these, 31,815 patients (58%) were treated in the CCM group (26 ICUs), 19,340 patients (35%) were treated in the cardiology group (12 ICUs), and 3780 patients (7%) were treated in the indeterminate group (4 ICUs). In adjusted models, no specific group based on ICU attending physician training background was associated with lower mortality (CCM vs. cardiology, odds ratio: 0.75, 95% confidence interval: 0.48-1.18), or lower incidence of cardiac arrest, or prolonged hospital length of stay, or prolonged mechanical ventilation.
This large observational study did not demonstrate any impact of ICU attending training background on outcomes in children undergoing heart operations.
目前成为小儿心脏重症监护医师的培训途径差异很大，医生来自小儿重症监护、小儿心脏病学、新生儿学或小儿麻醉等不同的培训背景。
评估心脏重症监护病房（ICU）主治医生的培训背景对接受心脏手术儿童的治疗结果的影响。
纳入在参与儿科健康信息系统数据库的医院接受心脏手术的1天至18岁年龄组患者（2010 - 2015年）。
根据ICU中大多数主治医生的培训背景，将参与研究的ICU分为三组：重症医学（CCM）、心脏病学和不确定组。
采用多变量逻辑回归模型评估ICU医生培训背景与研究结果之间的关联。
共纳入来自42个ICU的54935例患者。其中，31815例患者（58%）在CCM组（26个ICU）接受治疗，19340例患者（35%）在心脏病学组（12个ICU）接受治疗，3780例患者（7%）在不确定组（4个ICU）接受治疗。在调整模型中，基于ICU主治医生培训背景的特定组与较低死亡率（CCM组与心脏病学组，优势比：0.75，95%置信区间：0.48 - 1.18）、较低心脏骤停发生率、较长住院时间或较长机械通气时间均无关联。
这项大型观察性研究未显示ICU主治医生培训背景对接受心脏手术儿童的治疗结果有任何影响。
