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April 26, 1995

Quality of Care and Mortality in Pediatric Intensive Care Units-Reply

Author Affiliations

Children's National Medical Center Washington, DC

JAMA. 1995;273(16):1259. doi:10.1001/jama.1995.03520400028036

In Reply.  —We appreciate the opportunity to respond to Dr Kan and Dr Green. In our investigation of 16 randomly selected pediatrie ICUs, mortality rates adjusted for severity of illness, diagnosis, and other risk factors were higher in medical school teaching hospitals and lower in hospitals with pediatrie intensivists. Post hoc analyses indicated that the house officers caring for pediatrie ICU patients may explain the teaching hospital effect. We continue to believe this explanation is plausible. Increased mortality has been associated with residents with inadequate supervision.1 Adverse events in ICUs are more likely than in other hospital locations to result in serious disability and/or death.2 Since resident turnover is high, adverse events associated with learning could result in extra deaths. Within this context, a reasonable assumption is that in-house critical care fellows, since they are fully trained pediatricians, provide similar care to pediatrie ICUs without house officers.As

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