Regionalization of Critical Care Medicine

Outcome of children with different accessibility to tertiary pediatric intensive care in a developing country – a prospective cohort study

“…Proponents of a centralized system of provision advocate the development of a geographically integrated service (Frank Shann, personal communication), citing improved outcomes of children treated in tertiary PICUs compared to community and general ICUs [2,16,17]. Opponents instead seek investment to develop a service for children within the existing general ICUs of large district hospitals, arguing that such a local network mod-100 el of delivery will achieve similarly good outcomes at a fraction of the cost [18,19] and avoid potentially hazardous transfers of critically ill children by unskilled personnel [4]. With the current system of community hospital-regional center referral pattern, we have shown that initial differences in access to tertiary critical care resources did not affect survival if the patient eventually received care in a tertiary center.…”