Evaluation of the impact of trained pediatric intensivists on patient management in intensive care unit: An uncontrolled before-after study

Abstract

It is known that the presence of a pediatric intensivist in the pediatric intensive care unit (PICU) improves the quality of patient care and treatment. In this study, it was aimed to determine the differences in the quality of patient care between the period when a pediatric intensivist is actively working and the period when he/she is not actively working. This is a retrospective cohort observational study conducted in Batman Training and Research Hospital. Children aged 1 month to 18 years old admitted to the PICU between October 2020 and March 2021 were enrolled in the study. The 6-month period without an intensivist was compared with the period when the patients were treated by a pediatric intensivist.  Demographic data and mortality of the group were recorded and compared between groups. There was no statistically significant difference between the groups in terms of number, gender, and age. The mean Pediatric Risk of Mortality (PRISM) score and Pediatric Death Rate (PDR) were higher in group 2, and these differentiations were statistically significant (0.39 ± 0.18vs 4.57 ± 2.36, p<0.001; 1.08 ± 0.15 vs 2,05 ± 1.25, p<0.001). Although mortality was statistically higher in group 2, there were no invasive procedures like mechanical ventilatory support, dialysis, and central venous catheter applications in group 1. The ratio of patient acceptance from other hospitals was higher in group 2 (p<0.001). In intensive care units under the management of intensivists, clinical follow-up of critical and risky patients can be performed on-site. This protects from transfer difficulties. Invasive interventions can be performed on patients with less risk, and yet mortality is below average. Pediatric intensive care units should be managed by pediatric intensivists and their numbers should be increased.