Volume and Outcome in Pediatric Critical Care: How Much is Enough?
Decades of observational studies have documented an inverse relationship between patient volume and mortality in adult medicine, particularly related to surgical procedures [1–3]. The weight of evidence is so great as to have led Arnold Epstein to call for an end to the debate in a recent New England Journal of Medicine editorial, titled “Volume and outcome — It is time to move ahead” . However, what that means for pediatric critical care is less clear, for the evidence of a volume-outcome relationship in pediatric critical care is much less extensive. And while pediatric critical care may be more regionalized in some countries than adult critical care, many critically ill children in the United States are still treated and die at non-tertiary centers [5–7]. Whether that is appropriate in light of the current state of the literature is unsettled.
KeywordsPediatric Intensive Care Unit Hospital Discharge Data Pediatric Critical Care Pediatric ICUs Pediatric Intensive Care Unit Mortality
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