Who Falls Under the Pediatric Neurocritical Care Umbrella?*

SystemsPICUs in the United States were established in the mid 1960s to care for critically ill children in a specialized environment where nurses and physicians could monitor and treat children postoperatively and with acute respiratory illnesses (1).Over the past 50 years, pediatric critical care medicine has exponentially expanded both in its size and ability to provide life-saving care to children with more diverse injuries and organ failures.Dedicated cardiac ICUs were formed in the 1990s at many institutions to provide subspecialty critical care for infants after congenital heart disease surgery with focused resources and multidisciplinary teams including intensivists, cardiologists, and cardiothoracic surgeons (2).Pediatric neurocritical care has been developing since the early 2000s, with the recognition that children with neurologic critical illness require distinct resources and may benefit from subspecialized care provided by multidisciplinary teams of intensivists, neurologists, and neurosurgeons (3, 4).Characterizing the epidemiology of patients with neurologic diagnoses is critically important to understand the impact these patients have on resource utilization, capacity management, and subspecialty services.To date, it has been challenging to determine which patients fall under the neurocritical care umbrella.In this issue of Pediatric Critical Care Medicine, DeSanti et al (5) tackle this important issue by using the Virtual Pediatric Systems (VPS) database to estimate the prevalence of neurocritical care patients in U.S. PICUs and to characterize their utilization of ICU resources in comparison to patients without neurologic diagnoses.Patients were dichotomized into neurocritical care and general PICU cohorts based on their primary VPS diagnosis.Neurocritical care diagnoses were drawn from a prespecified list that included various causes of acute brain injury, seizures and status epilepticus, spinal cord pathology, and neurosurgical disorders.Twenty-four percent of the nearly 130,000 patients who received care in 123 PICUs over a 1-year period had a primary VPS neurocritical care diagnosis.Compared with general PICU patients, neurocritical patients were older, had increased use of ICU resources including intubation, Foley catheters, and arterial lines, higher mortality rates, and decreased functional status for survivors.The neurocritical The authors have disclosed that they do not have any potential conflicts of interest.