Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance.

Autor:	Frankel LR; Department of Pediatrics and Critical Care Services, California Pacific Medical Center, San Francisco, CA., Hsu BS; Pediatric Critical Care, Department of Pediatrics, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD., Yeh TS; Department of Pediatrics, Saint Barnabas Medical Center, Livingston, NJ., Simone S; Pediatric Intensive Care Unit, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD., Agus MSD; Division of Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA., Arca MJ; Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI., Coss-Bu JA; Pediatrics and Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX., Fallat ME; Division of Pediatric Surgery, University of Louisville, Norton Children's Hospital, Louisville, KY., Foland J; Pediatric Intensive Care, Department of Pediatrics, The Studer Family Children's Hospital at Sacred Heart, Pensacola, FL., Gadepalli S; Division of Pediatric Surgery, Department of Pediatrics, University of Michigan, Ann Arbor, MI., Gayle MO; Pediatric Intensive Care, Wolfson Children's Hospital, Gainsville, FL., Harmon LA; Department of Quality, Society of Critical Care Medicine, Mount Prospect, IL., Hill V; Hospital Medicine, Department of Pediatrics, Baylor College of Medicine at Children's Hospital of San Antonio, San Antonio, TX., Joseph CA; Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Oakland, Danville, CA., Kessel AD; Pediatric Critical Care Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY., Kissoon N; Medical Affairs, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada., Moss M; Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AK., Mysore MR; Pediatrics, Critical Care Medicine, Department of Pediatrics, UNMC College of Medicine, Omaha, NE., Papo ME; Pediatric Intensive Care Unit, Department of Pediatrics, Medical City Children's Hospital, Dallas, TX., Rajzer-Wakeham KL; Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Wisconsin, Wauwatosa, WI., Rice TB; Pediatric Critical Care Medicine, Department of Pediatrics, The Medical College of Wisconsin, Arena, WI., Rosenberg DL; Pediatrics and Pediatric Intensive Care, Department of Pediatrics, Grand Strand Regional Medical Center, Myrtle Beach, SC., Wakeham MK; Pediatrics (Critical Care Section), Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI., Conway EE Jr; Pediatrics and Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Beth Israel and Mount Sinai West Hospitals, New York City, NY.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2019 Sep; Vol. 20 (9), pp. 847-887.
DOI:	10.1097/PCC.0000000000001963
Abstrakt:	Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine's 2004 Guidelines and levels of care for PICU. Design: A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016. Only 21 pediatric studies evaluating outcomes related to pediatric level of care, specialized PICU, patient volume, or personnel. Of these, 13 studies were large retrospective registry data analyses, six small single-center studies, and two multicenter survey analyses. Limited high-quality evidence was found, and therefore, a modified Delphi process was used. Liaisons from the American Academy of Pediatrics were included in the panel representing critical care, surgical, and hospital medicine expertise for the development of this practice guidance. The title was amended to "practice statement" and "guidance" because Grading of Recommendations, Assessment, Development, and Evaluation methodology was not possible in this administrative work and to align with requirements put forth by the American Academy of Pediatrics. Methods: The panel consisted of two groups: a voting group and a writing group. The panel used an iterative collaborative approach to formulate statements on the basis of the literature review and common practice of the pediatric critical care bedside experts and administrators on the task force. Statements were then formulated and presented via an online anonymous voting tool to a voting group using a three-cycle interactive forecasting Delphi method. With each cycle of voting, statements were refined on the basis of votes received and on comments. Voting was conducted between the months of January 2017 and March 2017. The consensus was deemed achieved once 80% or higher scores from the voting group were recorded on any given statement or where there was consensus upon review of comments provided by voters. The Voting Panel was required to vote in all three forecasting events for the final evaluation of the data and inclusion in this work. The writing panel developed admission recommendations by level of care on the basis of voting results. Results: The panel voted on 30 statements, five of which were multicomponent statements addressing characteristics specific to PICU level of care including team structure, technology, education and training, academic pursuits, and indications for transfer to tertiary or quaternary PICU. Of the remaining 25 statements, 17 reached consensus cutoff score. Following a review of the Delphi results and consensus, the recommendations were written. Conclusions: This practice statement and level of care guidance manuscript addresses important specifications for each PICU level of care, including the team structure and resources, technology and equipment, education and training, quality metrics, admission and discharge criteria, and indications for transfer to a higher level of care. The sparse high-quality evidence led the panel to use a modified Delphi process to seek expert opinion to develop consensus-based recommendations where gaps in the evidence exist. Despite this limitation, the members of the Task Force believe that these recommendations will provide guidance to practitioners in making informed decisions regarding pediatric admission or transfer to the appropriate level of care to achieve best outcomes.
Databáze:	MEDLINE
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