Punkaj Gupta, Mallikarjuna Rettiganti, Tom B. Rice, Randall C. Wetzel  Am. J. Resp. Crit. Care Med. Dec 15, 2016. vol. 194, no. 12: 1506 - 1513

Rationale: 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.

Objectives: To evaluate the association of 24/7 in-house coverage with outcomes in children with critical illness.

Methods: 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.

Measurements and Main Results: 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).

Conclusions: 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.

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