title: 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 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.
authors: Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA. kerri.larovere@childrens.harvard.edu
authors: Kerri L
authors: KL
authors: LaRovere
authors: Robert J
authors: RJ
authors: Graham
authors: Robert C
authors: RC
authors: Tasker
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D009462:Neurology / Q000193:education*; D010372:Pediatrics / Q000193:education*; D012017:Referral and Consultation; D012121:Respiration, Artificial