Development of a Pediatric Neurocritical Care Service

Abstract

To describe the development of a Pediatric Neurocritical Care (PNCCM) service; define the patient population that requires the service and describe important outcome parameters. An analysis of prospectively collected data from a database was performed in a tertiary-care, academic children's hospital. Critically ill children who received a PNCCM consult between April, 2006 and May 2007 were included in the analysis. Demographic data (including age, Pediatric Intensive Care Unit (PICU) admission diagnosis, reason for PNCCM consult, timing of consult, and medical/neurological co-morbidities), outcome (PICU mortality and hospital length of stay) and result of consults (resources utilized, new consults or differential diagnoses suggested) were collected. Over a 14-month period, 373 PNCCM consults were obtained (total PICU admissions 1,423) at an average of 3.6 days +/- 0.5 after PICU admission. PNCCM consults had a higher mortality than overall PICU population (11.0% vs. 5.2%; P < 0.001) and longer hospital length of stay (18.5 days +/- 1.4 vs. 6.7 days +/- 1.9). The majority (64.1%) of PNCCM consults were admitted to the PICU with neurological diagnoses (status epilepticus was the most common). A significant percentage (35.9%) had critical medical conditions at presentation and the disorders of our PNCCM consults were very different from those observed in adult NCCM services. PNCCM consults suggested an additional and differential diagnosis in 148 children and an additional 105 consults from other services. More than 787 procedures or diagnostic neurological tests were performed in this cohort of children in the PICU. A PNCCM team was asked to assist in managing almost one-quarter of the total patient census in an urban, tertiary-care, teaching hospital. The number of consults is comparable to those observed in early studies in adult NCCM team development but the admission diagnoses are distinct. The PNCCM consulted on children with high mortality rates. Future studies will be needed to determine if the presence of a PNCCM can result in improved patient outcomes.