title: Impact of 24/7 In-Hospital Intensivist Coverage on Outcomes in Pediatric Intensive Care. A Multicenter Study.
abstract: The around-the-clock presence of an in-house attending critical care physician (24/7 coverage) is purported to be associated with improved outcomes among high-risk children with critical illness.
  
  
  
  To evaluate the association of 24/7 in-house coverage with outcomes in children with critical illness.
  
  
  
  Patients younger than 18 years of age in the Virtual Pediatric Systems Database (2009-2014) were included. The main analysis was performed using generalized linear mixed effects multivariable regression models. In addition, multiple sensitivity analyses were performed to test the robustness of our findings.
  
  
  
  A total of 455,607 patients from 125 hospitals were included (24/7 group: 266,319 patients; no 24/7 group: 189,288 patients). After adjusting for patient and center characteristics, the 24/7 group was associated with lower mortality in the intensive care unit (ICU) (24/7 vs. no 24/7; odds ratio [OR], 0.52; 95% confidence interval [CI], 0.33-0.80; P = 0.002), a lower incidence of cardiac arrest (OR, 0.73; 95% CI, 0.54-0.99; P = 0.04), lower mortality after cardiac arrest (OR, 0.56; 95% CI, 0.340-0.93; P = 0.02), a shorter ICU stay (mean difference, -0.51 d; 95% CI, -0.93 to -0.09), and shorter duration of mechanical ventilation (mean difference, -0.68 d; 95% CI, -1.23 to -0.14).
  
  
  
  In this large observational study, we demonstrated that pediatric critical care provided in the ICUs staffed with a 24/7 intensivist presence is associated with improved overall patient survival and survival after cardiac arrest compared with patients treated in ICUs staffed with discretionary attending coverage. However, results from a few sensitivity analyses leave some ambiguity in these results.
authors.affiliation: 1 Division of Pediatric Cardiology, and.|2 Arkansas Children's Hospital Research Institute, Little Rock, Arkansas.
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: 3 Section of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.|2 Arkansas Children's Hospital Research Institute, Little Rock, Arkansas.
authors.forename: Mallikarjuna
authors.initials: M
authors.lastname: Rettiganti
authors.affiliation: 4 Virtual Pediatric Systems, LLC, Los Angeles, California.|5 Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and.
authors.forename: Tom B
authors.initials: TB
authors.lastname: Rice
authors.affiliation: 4 Virtual Pediatric Systems, LLC, Los Angeles, California.|6 Division of Critical Care Medicine, Department of Pediatrics and Anesthesiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Wetzel
mesh_terms: D002648:Child; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D020445:Hospitalists / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D000078329:Workforce
keywords: 24/7 coverage; children; critical illness; in-house coverage; mortality