Neurocritical Care

, Volume 10, Issue 1, pp 4–10 | Cite as

Development of a Pediatric Neurocritical Care Service

  • Michael J. Bell
  • Jessica Carpenter
  • Alicia K. Au
  • Robert F. Keating
  • John S. Myseros
  • Amanda Yaun
  • Steven Weinstein
Original Article



To describe the development of a Pediatric Neurocritical Care (PNCCM) service; define the patient population that requires the service and describe important outcome parameters.


An analysis of prospectively collected data from a database was performed in a tertiary-care, academic children’s hospital. Critically ill children who received a PNCCM consult between April, 2006 and May 2007 were included in the analysis. Demographic data (including age, Pediatric Intensive Care Unit (PICU) admission diagnosis, reason for PNCCM consult, timing of consult, and medical/neurological co-morbidities), outcome (PICU mortality and hospital length of stay) and result of consults (resources utilized, new consults or differential diagnoses suggested) were collected.


Over a 14-month period, 373 PNCCM consults were obtained (total PICU admissions 1,423) at an average of 3.6 days ± 0.5 after PICU admission. PNCCM consults had a higher mortality than overall PICU population (11.0% vs. 5.2%; P < 0.001) and longer hospital length of stay (18.5 days ± 1.4 vs. 6.7 days ± 1.9). The majority (64.1%) of PNCCM consults were admitted to the PICU with neurological diagnoses (status epilepticus was the most common). A significant percentage (35.9%) had critical medical conditions at presentation and the disorders of our PNCCM consults were very different from those observed in adult NCCM services. PNCCM consults suggested an additional and differential diagnosis in 148 children and an additional 105 consults from other services. More than 787 procedures or diagnostic neurological tests were performed in this cohort of children in the PICU.


A PNCCM team was asked to assist in managing almost one-quarter of the total patient census in an urban, tertiary-care, teaching hospital. The number of consults is comparable to those observed in early studies in adult NCCM team development but the admission diagnoses are distinct. The PNCCM consulted on children with high mortality rates. Future studies will be needed to determine if the presence of a PNCCM can result in improved patient outcomes.


Pediatric neurocritical care Neurocritical care  Mortality  Demographics 



Michael J. Bell is supported by HD044716 and a grant from United Cerebral Palsy.


  1. 1.
    Epstein D, Brill JE. A history of pediatric critical care medicine. Pediatr Res 2005;58:987–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Pollack MM, Katz RW, Ruttimann UE, Getson PR. Improving the outcome and efficiency of intensive care: the impact of an intensivist. Crit Care Med 1988;16:11–7.PubMedGoogle Scholar
  3. 3.
    Effect of intravenous recombinant tissue plasminogen activator on ischemic stroke lesion size measured by computed tomography. NINDS; The National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study Group. Stroke 2000;31:2912–9.Google Scholar
  4. 4.
    Clark WM, Albers GW, Madden KP, Hamilton S. The rtPA (alteplase) 0- to 6-hour acute stroke trial, part A (A0276g): results of a double-blind, placebo-controlled, multicenter study. Thromblytic therapy in acute ischemic stroke study investigators. Stroke 2000;31:811–6.PubMedGoogle Scholar
  5. 5.
    Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549–56.CrossRefGoogle Scholar
  6. 6.
    Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Mazzeo AT, Bullock R. Monitoring brain tissue oxymetry: will it change management of critically ill neurologic patients? J Neurol Sci 2007;261:1–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Zauner A, Daugherty WP, Bullock MR, Warner DS. Brain oxygenation and energy metabolism: part I-biological function and pathophysiology. Neurosurgery 2002;51:289–301.PubMedCrossRefGoogle Scholar
  9. 9.
    Bullock R, Zauner A, Woodward JJ, et al. Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 1998;89:507–18.PubMedCrossRefGoogle Scholar
  10. 10.
    Hlatky R, Valadka AB, Goodman JC, Contant CF, Robertson CS. Patterns of energy substrates during ischemia measured in the brain by microdialysis. J Neurotrauma 2004;21:894–906.PubMedCrossRefGoogle Scholar
  11. 11.
    Hlatky R, Furuya Y, Valadka AB, Goodman JC, Robertson CS. Microdialysate nitrate/nitrite levels following severe head injury. Acta Neurochir Suppl 2002;81:331–3.PubMedGoogle Scholar
  12. 12.
    Robertson CS, Gopinath SP, Goodman JC, Contant CF, Valadka AB, Narayan RK. SjvO2 monitoring in head-injured patients. J Neurotrauma 1995;12:891–6.PubMedGoogle Scholar
  13. 13.
    Mayer SA, Kowalski RG, Presciutti M, et al. Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med 2004;32:2508–15.PubMedCrossRefGoogle Scholar
  14. 14.
    Diringer MN. Treatment of fever in the neurologic intensive care unit with a catheter-based heat exchange system. Crit Care Med 2004;32:559–64.PubMedCrossRefGoogle Scholar
  15. 15.
    Fernandez A, Schmidt JM, Claassen J, et al. Fever after subarachnoid hemorrhage: risk factors and impact on outcome. Neurology 2007;68:1013–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Mayer SA. Refrigerated intravenous fluids: kick-starting the cooling process. Crit Care Med 2005;33:2844–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Bleck TP, Smith MC, Pierre-Louis SJ, Jares JJ, Murray J, Hansen CA. Neurologic complications of critical medical illnesses. Crit Care Med 1993;21:98–103.PubMedCrossRefGoogle Scholar
  18. 18.
    Mirski MA, Chang CW, Cowan R. Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care: evidence-based support for an intensivist-directed specialty ICU model of care. J Neurosurg Anesthesiol 2001;13:83–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ. Specialist neurocritical care and outcome from head injury. Intensive Care Med 2002;28:547–53.PubMedCrossRefGoogle Scholar
  20. 20.
    Suarez JI, Zaidat OO, Suri MF, et al. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med 2004;32:2311–7.PubMedGoogle Scholar
  21. 21.
    Varelas PN, Eastwood D, Yun HJ, et al. Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit. J Neurosurg 2006;104:713–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr Crit Care Med 2003;4:S1–73.CrossRefGoogle Scholar
  23. 23.
    Rincon F, Mayer SA. Neurocritical care: a distinct discipline? Curr Opin Crit Care 2007;13:115–21.PubMedCrossRefGoogle Scholar
  24. 24.
    Ropper A, Gress M, Green D, Mayer S, Bleck T. Neurological and neurosurgical intensive care. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2003.Google Scholar
  25. 25.
    Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med 2001;29:635–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Pollack MM, Patel KM, Ruttimann UE. The Pediatric Risk of Mortality III-Acute Physiology Score (PRISM III-APS): a method of assessing physiologic instability for pediatric intensive care unit patients. J Pediatr 1997;131:575–81.PubMedCrossRefGoogle Scholar
  27. 27.
    Chang AC. Pediatric cardiac intensive care: current state of the art and beyond the millennium. Curr Opin Pediatr 2000;12:238–46.PubMedCrossRefGoogle Scholar
  28. 28.
    Chang AC. How to start and sustain a successful pediatric cardiac intensive care program: a combined clinical and administrative strategy. Pediatr Crit Care Med 2002;3:107–11.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2008

Authors and Affiliations

  • Michael J. Bell
    • 1
    • 2
  • Jessica Carpenter
    • 3
  • Alicia K. Au
    • 2
  • Robert F. Keating
    • 4
  • John S. Myseros
    • 4
  • Amanda Yaun
    • 4
  • Steven Weinstein
    • 3
  1. 1.Division of Critical Care MedicineChildren’s National Medical CenterWashingtonUSA
  2. 2.Division of Pediatric Critical Care Medicine, Children’s Hospital of PittsburghUniversity of PittsburghPittsburghUSA
  3. 3.Department of NeurologyChildren’s National Medical CenterWashingtonUSA
  4. 4.Department of NeurosurgeryChildren’s National Medical CenterWashingtonUSA

Personalised recommendations