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Pediatric neurocritical care: a neurology consultation model and implication for education and training
Kerri L LaRovere1, Robert J Graham, Robert C Tasker
1Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA. kerri.larovere@childrens.harvard.edu
Insights
A specialized Neurology Consulting Team in pediatric intensive care units improved patient outcomes and provided valuable training. This model enhances care for critically ill children with neurological conditions.
Area of Science:
- Neurology
- Pediatric Intensive Care
- Neurocritical Care
Background:
- Pediatric neurocritical care is an emerging subspecialty.
- This field integrates pediatric intensive care and pediatric neurology.
- Developing expertise is crucial for training and education.
Purpose of the Study:
- To describe a Neurology Consulting Team model in the intensive care unit.
- To evaluate the impact of this service on patient care and training.
Main Methods:
- Retrospective review of 32-month Neurology Consulting Team referral data.
- Analysis of patient demographics, diagnoses, interventions, and outcomes.
- Assessment of consultation frequency and neurodiagnostic testing.
Main Results:
- 689 of 3719 ICU patients (19%) were assessed.
- Common diagnoses included seizures, neurosurgical, cerebrovascular, and CNS infections.
- Mortality was 7% for consulted patients versus 2% for general ICU population (P < 0.01).
- The team provided 4592 consultations, with a median of 2 per patient.
- 75% of patients required neurodiagnostic investigations (median 2 per patient).
Conclusions:
- The Neurology Consulting Team model effectively manages critically ill pediatric patients with neurological conditions.
- This service provides significant clinical experience for trainees.
- Findings have implications for curriculum development in pediatric critical care and neurology.
Abstract:
Pediatric neurocritical care is developing specialization within pediatric intensive care and pediatric neurology practice, and the evolving clinical expertise has relevance to training and education in both fields. We describe a model of service using a Neurology Consulting Team in the intensive care unit setting. Medical records were reviewed from a 32-month cohort of Neurology Consulting Team referrals. Six hundred eighty-nine (19%) of 3719 patients admitted to the intensive care unit were assessed by the team. The most common diagnostic categories were seizures, neurosurgical, cerebrovascular, or central nervous system infection. Fifty-seven percent (350 of 615 patients) required mechanical ventilation. Cohort mortality was 7% vs 2% for the general intensive care population (P < 0.01). The team provided 4592 initial and subsequent consultations; on average there were five to six new consultations per week. Each patient had a median of two (interquartile range, 1 to 6) consultations during admission. Three quarters of the cohort required neurodiagnostic investigation (1625 tests), with each patient undergoing a median of two (range, 0 to 3) studies. Taken together, the subset of pediatric intensive care unit patients undergoing neurology consultation, investigation, and management represents a significant practice experience for trainees, which has implications for future curriculum development in both pediatric critical care medicine and pediatric neurology.
