title: Association of house staff training with mortality in children with critical illness.
abstract: OBJECTIVE
  To evaluate the association of house staff training with mortality in children with critical illness.
  
  
  METHODS
  Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. The study population was divided in two study groups: hospitals with residency programme only and hospitals with both residency and fellowship programme. Control group constituted hospitals with no residency or fellowship programme. The primary study outcome was mortality before intensive care unit (ICU) discharge. Multivariable logistic regression models were fitted to evaluate association of training programmes with ICU mortality.
  
  
  RESULTS
  A total of 336 335 patients from 108 centres were included. Case-mix of patients among the hospitals with training programmes was complex; patients cared for in the hospitals with training programmes had greater severity of illness, had higher resource utilisation and had higher overall admission risk of death compared to patients cared for in the control hospitals. Despite caring for more complex and sicker patients, the hospitals with training programmes were associated with lower odds of ICU mortality.
  
  
  CONCLUSIONS
  Our study establishes that ICU care provided in hospitals with training programmes is associated with improved adjusted survival rates among the Virtual PICU database hospitals in the United States.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Section of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Section of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Mallikarjuna
authors.initials: M
authors.lastname: Rettiganti
authors.affiliation: Virtual PICU Systems, LLC, Los Angeles, CA, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Lauer
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
authors.affiliation: Virtual PICU Systems, LLC, Los Angeles, CA, USA.|Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Tom B
authors.initials: TB
authors.lastname: Rice
authors.affiliation: Virtual PICU Systems, LLC, Los Angeles, CA, USA.|Division of Critical Care Medicine, Department of Pediatrics and Anesthesiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Barry P
authors.initials: BP
authors.lastname: Markovitz
authors.affiliation: Virtual PICU Systems, LLC, Los Angeles, CA, USA.|Division of Critical Care Medicine, Department of Pediatrics and Anesthesiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Wetzel
mesh_terms: D000293:Adolescent; D002648:Child; D016638:Critical Illness / Q000401:mortality*; D003953:Diagnosis-Related Groups; D005257:Fellowships and Scholarships; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007396:Internship and Residency; D016015:Logistic Models; D008505:Medical Staff, Hospital / Q000193:education*; D014481:United States
keywords: Children; Critical illness; Fellowship; Intensive care; Mortality