Department of Neurology, Boston Children's Hospital, Boston, MA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.
Pediatr Crit Care Med. 2018 Nov;19(11):1039-1045. doi: 10.1097/PCC.0000000000001708.
Pediatric neurocritical care as a conceptual service is relatively new, and implementation of such specialized services may improve outcomes for children with disorders of the brain or spinal cord. How many pediatric neurocritical care services currently exist in the United States, and attitudes about such a service are unknown.
Web-based survey, distributed by e-mail.
Survey was sent to PICU Medical Directors and Program Directors of Pediatric Neurosurgery fellowship and Child Neurology residency programs.
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A total of 378 surveys were distributed; 161 respondents representing 128 distinct hospitals completed the survey (43% response rate). Thirty-five percent (45/128) reported having a pediatric neurocritical care service. The most common type of service used a consultation model (82%; 32/39 responses). Other types of services were intensivist-led teams in the PICU (five hospitals) and dedicated PICU beds (two hospitals). Hospital characteristics associated with availability of pediatric neurocritical care services were level 1 trauma status (p = 0.017), greater numbers of PICU beds (χ [6, n = 128] = 136.84; p < 0.01), and greater volume of children with pediatric neurocritical care conditions (χ [3, n = 128] = 20.16; p < 0.01). The most common reasons for not having a pediatric neurocritical care service were low patient volume (34/119 responses), lack of subspecialists (30/119 responses), and lack of interest by PICU faculty (25/119 responses). The positive impacts of a pediatric neurocritical care service were improved interdisciplinary education/training (16/45 responses), dedicated expertise (13/45 responses), improved interservice communication (9/45 responses), and development/implementation of guidelines and protocols (9/45 responses). The negative impacts of a pediatric neurocritical care service were disagreement among consultants (2/45 responses) and splitting of the PICU population (2/45 responses).
At least 45 specialized pediatric neurocritical care services exist in the United States. Eighty percent of these services are a consultation service to the PICU. Hospitals with level 1 trauma status, greater numbers of PICU beds, and greater numbers of patients with pediatric neurocritical care conditions were associated with the existence of pediatric neurocritical care as a clinical service.
儿科神经危重症护理作为一种概念性服务相对较新，而实施此类专业服务可能会改善患有脑或脊髓疾病儿童的预后。目前在美国有多少家儿科神经危重症护理服务机构，以及人们对这种服务的态度尚不清楚。
基于网络的调查，通过电子邮件发送。
调查发送给了 PICU 医疗主任和小儿神经外科 fellowship以及儿童神经科住院医师项目的项目主任。
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共发放了 378 份调查；161 名代表 128 家不同医院的受访者完成了调查（43%的回应率）。35%（45/128）报告说有儿科神经危重症护理服务。最常见的服务类型是使用咨询模式（82%；39 个回复中的 32 个）。其他类型的服务是 PICU 中的重症监护医生领导的团队（5 家医院）和专门的 PICU 床位（2 家医院）。与儿科神经危重症护理服务提供相关的医院特征是 1 级创伤状态（p = 0.017）、更多的 PICU 床位（χ[6，n = 128] = 136.84；p < 0.01）和更多患有儿科神经危重症护理条件的儿童（χ[3，n = 128] = 20.16；p < 0.01）。没有儿科神经危重症护理服务的最常见原因是患者数量低（34/119 个回复）、缺乏专家（30/119 个回复）和 PICU 工作人员缺乏兴趣（25/119 个回复）。儿科神经危重症护理服务的积极影响包括改善跨学科教育/培训（16/45 个回复）、专门的专业知识（13/45 个回复）、改善服务间沟通（9/45 个回复）和制定/实施指南和方案（9/45 个回复）。儿科神经危重症护理服务的负面影响包括顾问之间的意见分歧（2/45 个回复）和 PICU 人群的分割（2/45 个回复）。
至少在美国有 45 家专门的儿科神经危重症护理服务机构。这些服务中有 80%是向 PICU 提供的咨询服务。具有 1 级创伤状态、更多 PICU 床位和更多患有儿科神经危重症护理条件的患者的医院与儿科神经危重症护理作为临床服务的存在相关。
