Pediatric Neurocritical Care: A Neurology Consultation Model and Implication for Education and Training

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 int...

Full description

Saved in:
Bibliographic Details
Published in:Pediatric neurology 2013-03, Vol.48 (3), p.206-211
Main Authors: LaRovere, Kerri L., MD, Graham, Robert J., MD, Tasker, Robert C., MBBS, MD
Format: Article
Language:English
Subjects:
Adolescent
Brain Diseases - therapy
Central nervous system
Child
Child, Preschool
Critical Care
Humans
Infant
Infection
Intensive care units
Intensive Care Units, Pediatric
medical records
Mortality
Neurology
Neurology - education
Neurosurgery
Pediatrics
Pediatrics - education
Referral and Consultation
Respiration, Artificial
Seizures
Specialization
Ventilation
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
ISSN:0887-8994
1873-5150
DOI:10.1016/j.pediatrneurol.2012.12.006