Mortality Reduction in Pediatric Intensive Care Units Using Telemedicine

Introduction: The use of telemedicine in the Intensive Care Unit (ICU) is studied worldwide, however, its impact in pediatric ICUs (PICUs) is poorly studied. Brazil is a country with continental dimensions and it faces challenges such as underserved healthcare assistance. Methods: We conducted a before-and-after study in order to evaluate the impact of telemedicine in mortality rates and length of stay in two PICUs of the Brazilian Unified Public Health System. The sample was comprised by 940 patients, in which 426 were pre-telemedicine and 514 were post-telemedicine. The intervention occurred through daily telerounds between the both healthcare team from the command center and the ICUs assisted by telemedicine. Results: Mortality in unit A was 18·86% during the pre-telemedicine period, comparing with 9·29% in the post-telemedicine (p = 0·0054). In unit B, mortality was 10·76% pre-telemedicine comparing to 9·72% post-telemedicine (p = 0·6922) and the standardized mortality ratio changed from 1·10 to 0·99 (p = 0·9002). Median Length Of Stay (LOS) in unit A was 8 days (IQR 14 – 4) pre-telemedicine and 8 days (IQR 15 – 5) post-telemedicine (p = 0·64). In unit B, median LOS was 6 days (IQR 12 – 3) pre-telemedicine and 8 days (IQR 15·5 – 4) post-telemedicine (p = 0·0013). Logistic regression showed association between telemedicine implementation and significant reduction of the mortality rate in unit A (OR 2·31; 95% CI 1·27 – 4·20). The same result was not observed in unit B (OR 1·13; 95% CI 0·63 – 2·00). However, considering both units we observed a favorable association between adhering to the recommendations made by the command center’s team and reduction of mortality (OR 4·81; 95% CI 1·06 – 3·16). Interpretation: In conclusion, we demonstrated that the implementation of telemedicine in PICUs have the ability to significantly decrease mortality by associating the team’s continuing education through telerounds. Funding: Provided by the Brazilian Ministry of Health, through the Institutional Development Program of the Brazilian National Health System (PROADI-SUS). Declaration of Interest: None to declare. Ethical Approval: The project underwent evaluation of the institution’s Ethical Review Board (CAAE: 00781218·0·0000·5330).