Pediatric Neurocritical Care: Evolution of a New Clinical Service in PICUs Across the United States

Abstract

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.

Pediatric Critical Care Neurologists in the United States and Canada: A Survey of Clinical Practice Experience

“…Based on the results of our survey, the development of pediatric neurocritical care services appears to have evolved around a consultative model, and this is in keeping with prior reports. 1–3,6 However, within the consultative model, we found considerable heterogeneity; for example, the complement of intensive care units covered by respondents’ critical care neurology services varies widely, as does the call structure, ICU EEG interpretation practices, and incorporation of advanced practice providers. There remain gaps in our understanding of what constitutes the ideal pediatric neurocritical care service, and it is likely that the variability observed in this cohort, at least in part, reflects diverse institution-specific child neurology practice structures and resources.…”

“…Many respondents staff ICU follow-up clinics, collect outcome data, and participate in multicenter registries, all of which suggest an ideal milieu to quantify the impact of pediatric neurocritical clinical care on patient outcomes, another important mission cited by Riviello and Chang and echoed by others. 3,6,22 This comes with the caveat, however, that the outcome data collected is heterogeneous. This represents an area where collaboration and coordinated efforts among centers to develop and utilize common outcome measures could contribute significantly to the development of this field.…”

“…With more than 80% of pediatric neurocritical care services functioning as consultation services, often in association with an acute stroke service, 6 we hypothesize that child neurologists play important leadership roles and function as key clinical participants within these teams. However, there are limited data describing the demographics, training background, job structure, care team structure, or challenges faced by child neurologists practicing pediatric neurocritical care.…”

“…Children with acute neurologic illness account for a large proportion of pediatric intensive care unit (ICU) admissions, [1][2][3][4][5][6] as well as a high rate of pediatric ICU mortality. [7][8][9] Moreover, children with systemic illnesses often suffer neurologic complications of their primary disorder, 4 and children with chronic neurologic disease are at risk for decompensation, necessitating admission to the pediatric ICU.…”

“…10 This has contributed to a growing interest in pediatric neurocritical care (PNCC), with prior publications describing management of the pediatric neurocritical care patient, [11][12][13] programmatic structure, [1][2][3] education in critical care neurology, 2,14 and pediatric neurocritical care follow-up clinics. 15,16 Although there are no standards for the designation of a pediatric neurocritical care program or a neuroscience pediatric ICU, there are at least 45 self-reported pediatric neurocritical care services 6 and 8 neuroscience pediatric ICUs 17 in the United States (U.S).…”