Pediatric Intensivist Coverage and Outcomes in Critically Ill Children: A Cohort Study

Background The impact of trained intensivist staffing on critically ill pediatric patients requiring intensive care unit (ICU) admission is not clear. Objective To examine whether trained intensivist coverage is associated with improved survival outcomes in critically ill pediatric patients. Methods The analysis included all pediatric patients hospitalized in ICUs in South Korea from 2017 through 2021. The intensivist and nonintensivist groups included pediatric ICU patients in hospitals with and without trained intensivists, respectively. Results This study included 28 047 critically ill pediatric patients. Among them, 9909 (35.3%) were admitted to ICUs of hospitals where trained intensivists were dedicated to patient management, and these patients were subsequently assigned to the intensivist group. After propensity score matching, 16 992 critically ill pediatric patients (8496 in each group) were included in the final analysis. The all-cause mortality rates for 90 days and 1 year were 6.7% (566/8496) and 8.3% (709/8496) in the intensivist group, and 8.6% (732/8496) and 9.8% (835/8496) in the nonintensivist group, respectively. In the Cox regression analysis, the intensivist group showed 24% (hazard ratio [HR], 0.76; 95% CI, 0.68-0.85; P < .001) and 17% (HR, 0.83; 95% CI, 0.75-0.92; P < .001) lower 90-day and 1-year all-cause mortality rates, respectively, than the nonintensivist group. Conclusions The presence of pediatric intensivists in the ICU substantially reduced the mortality of critically ill pediatric patients. The findings highlight the significant role of pediatric intensivists in reducing long-term mortality among critically ill pediatric patients.