Growth and Changing Characteristics of Pediatric Intensive Care 2001-2016
Growth and Changing Characteristics of Pediatric Intensive Care 2001-2016
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DOI：
10.1097/ccm.0000000000003863
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发表时间：
2019-08-01
影响因子：
8.8
通讯作者：
Tasker, Robert
中科院分区：
文献类型：
--
作者：
Horak, Robin V.;Griffin, John F.;Tasker, Robert
目的：我们评估了2016年儿科重症监护的增长、分布和特点。设计：从先前的调查、数据库、在线搜索和临床医生网络中确定了设有PICU的医院。2016年发布了一份结构化的基于网络的调查，并与2001年的调查进行了比较。设置：PICU被定义为一个单独的单位，专门用于治疗有生命危险的儿童。PICU医院包含大于或等于1个PICU。主题：医生，医疗主任和护士管理人员。干预：无。测量和主要结果：测量了每名儿科人群（< 18岁）的PICU床位数，按州和地区划分的PICU床位分布，以及PICU特征及其与PICU床位的关系。从2001年到2016年，美国儿科人口增长了1.9%，超过7360万儿童，PICU医院从347家减少到344家（58家关闭，55家开放）。相比之下，PICU床位数增加了43%（4，135至5，908张床位）;每家PICU医院的PICU床位中位数从9张增加到12张（四分位数间距为8，20张床位）。2001年拥有大于或等于15张床位的PICU医院到2016年有显著的床位增长，而床位少于15张的PICU医院平均增长很少。2016年，每10万名美国儿童有8张PICU床位（2001年为5.7张），美国人口普查地区的床位供应存在差异（6.8至8.8张床位/10万名儿童）。63家PICU医院（18%）占PICU床位的47%。59家医院（17.2%）设有专门的PICU，48家为心脏病医院（增长129%）。随着每家医院PICU床位的增加，学术联系、体外膜肺氧合可用性和24小时住院重症监护人员的配备也有所增加。结论：在过去的15年里，美国PICU床位的增长超过了儿科人口的增长，PICU医院的比例相对较小，几乎占所有PICU床位的一半。PICU床位的可用性在美国各州和地区之间存在差异，可能会影响护理和应急准备的获得。
Objectives: We assessed the growth, distribution, and characteristics of pediatric intensive care in 2016. Design: Hospitals with PICUs were identified from prior surveys, databases, online searching, and clinician networking. A structured web-based survey was distributed in 2016 and compared with responses in a 2001 survey. Setting: PICUs were defined as a separate unit, specifically for the treatment of children with life-threatening conditions. PICU hospitals contained greater than or equal to 1 PICU. Subjects: Physician medical directors and nurse managers. Interventions: None. Measurements and Main Results: PICU beds per pediatric population (< 18 yr), PICU bed distribution by state and region, and PICU characteristics and their relationship with PICU beds were measured. Between 2001 and 2016, the U.S. pediatric population grew 1.9% to greater than 73.6 million children, and PICU hospitals decreased 0.9% from 347 to 344 (58 closed, 55 opened). In contrast, PICU bed numbers increased 43% (4,135 to 5,908 beds); the median PICU beds per PICU hospital rose from 9 to 12 (interquartile range 8, 20 beds). PICU hospitals with greater than or equal to 15 beds in 2001 had significant bed growth by 2016, whereas PICU hospitals with less than 15 beds experienced little average growth. In 2016, there were eight PICU beds per 100,000 U.S. children (5.7 in 2001), with U.S. census region differences in bed availability (6.8 to 8.8 beds/100,000 children). Sixty-three PICU hospitals (18%) accounted for 47% of PICU beds. Specialized PICUs were available in 59 hospitals (17.2%), 48 were cardiac (129% growth). Academic affiliation, extracorporeal membrane oxygenation availability, and 24-hour in-hospital intensivist staffing increased with PICU beds per hospital. Conclusions: U.S. PICU bed growth exceeded pediatric population growth over 15 years with a relatively small percentage of PICU hospitals containing almost half of all PICU beds. PICU bed availability is variable across U.S. states and regions, potentially influencing access to care and emergency preparedness.