title: Patient Outcomes of an International Telepediatric Cardiac Critical Care Program.
abstract: BACKGROUND
  An optimal model for telemedicine use in the international care setting has not been established. Our objective was to describe variables associated with patient outcome during the implementation of an international pediatric cardiac critical care (PCCC) telemedicine program.
  
  
  METHODS
  A retrospective review was performed of clinical records and a telemedicine database of patients admitted to the cardiac intensive care unit (CICU) at the Fundacion Cardiovascular de Colombia, Bucaramanga, Colombia, during the initial 10 months of our program, compared with patients admitted during a previous period. Information collected included demographic data, cardiac diagnosis and associated factors, Risk Adjustment for Congenital Heart Surgery (RACHS)-1 classification, and perioperative events. Primary outcome was composed of CICU and hospital mortality. Secondary outcomes were CICU and hospital length of stay (LOS).
  
  
  RESULTS
  Of the 553 patients who were included, teleconsultation was done for 71 (12.4%), with a total of 156 encounters, including 19 for patients on extracorporeal membrane oxygenation. Three hundred twenty-one recommendations were given, and 42 real-time interventions were documented. RACHS-1 distribution was similar between study periods (p=0.427). Teleconsulted patients were significantly younger (44 versus 24 months; p=0.03) and had higher surgical complexity than nonteleconsulted patients (p=0.01). RACHS-1 adjusted hospital survival was similar between study periods. CICU and hospital LOS intervals were significantly shorter in the telemedicine period (10 versus 17 days [p=0.02] and 22 versus 28 days [p<0.001]). In surgical cases, preoperative CICU LOS was significantly shorter (3 versus 6 days; p<0.001). Variables associated with hospital mortality were higher RACHS-1 categories, lower weight, bypass time longer than 150 min, and use of circulatory arrest, as well as the presence of sepsis or necrotizing enterocolitis. Those associated with increased LOS were lower weight, extracorporeal membrane oxygenation, and cross-clamp time longer than 60 min.
  
  
  CONCLUSIONS
  An international telemedicine service in PCCC was associated with lower CICU and hospital LOS. Prospective telemedicine interventions aimed to decrease mortality and LOS should focus on patients with higher RACHS-1 categories, lower-weight infants, and those with prolonged operative time and selective perioperative complications.
authors: 1 Division of Pediatric Cardiac Critical Care, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors: Alejandro José
authors: AJ
authors: Lopez-Magallon
authors: 1 Division of Pediatric Cardiac Critical Care, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors: Andrea Victoria
authors: AV
authors: Otero
authors: 1 Division of Pediatric Cardiac Critical Care, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors: Nils
authors: N
authors: Welchering
authors: 2 Department of Epidemiology, Cardiovascular Foundation of Colombia , Bucaramanga, Colombia .
authors: Anderson
authors: A
authors: Bermon
authors: 3 Department of Pediatric Cardiology and Cardiovascular Surgery, Cardiovascular Foundation of Colombia , Bucaramanga, Colombia .
authors: Victor
authors: V
authors: Castillo
authors: 3 Department of Pediatric Cardiology and Cardiovascular Surgery, Cardiovascular Foundation of Colombia , Bucaramanga, Colombia .
authors: Álvaro
authors: Á
authors: Duran
authors: 3 Department of Pediatric Cardiology and Cardiovascular Surgery, Cardiovascular Foundation of Colombia , Bucaramanga, Colombia .
authors: Javier
authors: J
authors: Castro
authors: 1 Division of Pediatric Cardiac Critical Care, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
authors: Ricardo
authors: R
authors: Muñoz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003105:Colombia / Q000453:epidemiology; D003422:Critical Care / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010414:Pennsylvania; D019114:Remote Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cardiology/cardiovascular disease; pediatrics; telecardiology; telemedicine