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Growth and Changing Characteristics of Pediatric Intensive Care 2001–2016

Horak, Robin V. MD1,2; Griffin, John F. MS3; Brown, Ann-Marie NP, PhD4,5; Nett, Sholeen T. MD, PhD6; Christie, LeeAnn M. MSN, RN7; Forbes, Michael L. MD4; Kubis, Sherri RN, BSN8; Li, Simon MD, MPH9,10; Singleton, Marcy N. ARNP6; Verger, Judy T. NP, PhD8; Markovitz, Barry P. MD, MPH1,2; Burns, Jeffrey P. MD, MPH3,11; Chung, Sarita A. MD12,13; Randolph, Adrienne G. MD, MS3,11,12; on behalf of the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network

doi: 10.1097/CCM.0000000000003863
Pediatric Critical Care

Objectives: We assessed the growth, distribution, and characteristics of pediatric intensive care in 2016.

Design: Hospitals with PICUs were identified from prior surveys, databases, online searching, and clinician networking. A structured web-based survey was distributed in 2016 and compared with responses in a 2001 survey.

Setting: PICUs were defined as a separate unit, specifically for the treatment of children with life-threatening conditions. PICU hospitals contained greater than or equal to 1 PICU.

Subjects: Physician medical directors and nurse managers.

Interventions: None.

Measurements and Main Results: PICU beds per pediatric population (< 18 yr), PICU bed distribution by state and region, and PICU characteristics and their relationship with PICU beds were measured. Between 2001 and 2016, the U.S. pediatric population grew 1.9% to greater than 73.6 million children, and PICU hospitals decreased 0.9% from 347 to 344 (58 closed, 55 opened). In contrast, PICU bed numbers increased 43% (4,135 to 5,908 beds); the median PICU beds per PICU hospital rose from 9 to 12 (interquartile range 8, 20 beds). PICU hospitals with greater than or equal to 15 beds in 2001 had significant bed growth by 2016, whereas PICU hospitals with less than 15 beds experienced little average growth. In 2016, there were eight PICU beds per 100,000 U.S. children (5.7 in 2001), with U.S. census region differences in bed availability (6.8 to 8.8 beds/100,000 children). Sixty-three PICU hospitals (18%) accounted for 47% of PICU beds. Specialized PICUs were available in 59 hospitals (17.2%), 48 were cardiac (129% growth). Academic affiliation, extracorporeal membrane oxygenation availability, and 24-hour in-hospital intensivist staffing increased with PICU beds per hospital.

Conclusions: U.S. PICU bed growth exceeded pediatric population growth over 15 years with a relatively small percentage of PICU hospitals containing almost half of all PICU beds. PICU bed availability is variable across U.S. states and regions, potentially influencing access to care and emergency preparedness.

1Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

2Department of Pediatrics, Keck School of Medicine, Los Angeles, CA.

3Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA.

4Critical Care Medicine, Akron Children’s Hospital, Akron, OH.

5School of Nursing at Emory University, Atlanta, GA.

6Department of Pediatrics, Children’s Hospital at Dartmouth, Lebanon, NH.

7PICU/Respiratory Rehabilitation Unit, Dell Children’s Medical Center of Central Texas, Austin, TX.

8Department of Nursing, Children’s Hospital of Philadelphia, Philadelphia, PA.

9Pediatric Critical Care Medicine, Maria Fareri Children’s Hospital, New York Medical College, Valhalla, NY.

10Department of Pediatrics, New York Medical College, Valhalla, NY.

11Departments of Anaesthesia, Harvard Medical School, Boston, MA.

12Department of Pediatrics, Harvard Medical School, Boston, MA.

13Division of Emergency Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA.

Dr. Horak and Mr. Griffin contributed equally to this work.

All authors made substantial contributions to the design of the study and/or survey and the interpretation of the data, critically revised the work for important intellectual content, and approved the final article for publication. Dr. Horak, Mr. Griffin, and Dr. Randolph also acquired and analyzed the data, drafted the initial article, and are accountable for all aspects of the work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

This work was funded by the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital (to Dr. Horak, Mr. Griffin, and Drs. Burns and Randolph) and the Center for the Critically Ill Child Mannion Family Fund (to Dr. Horak).

Dr. Randolph’s institution received funding from Center for the Critically Ill Child Mannion Family Fund and Genentech, and she received funding from La Jolla Pharmaceuticals, Bristol Myers-Squibb, and UptoDate (section editor for Pediatric Critical Care). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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