Impact of Telemedicine on Severity of Illness and Outcomes among Children Transferred from Referring Emergency Departments to a Children's Hospital PICU

Parul Dayal, Nayla M. Hojman, Jamie L. Kissee, Jacqueline Evans, JoAnne E Natale, Yunru Huang, Rebecca L. Litman, Thomas S Nesbitt, James P Marcin

Research output: Contribution to journalArticle

21 Scopus citations


Objectives: To compare the severity of illness and outcomes among children admitted to a children's hospital PICU from referring emergency departments with and without access to a pediatric critical care telemedicine program. Design: Retrospective cohort study. Setting: Tertiary academic children's hospital PICU. Patients: Pediatric patients admitted directly to the PICU from referring emergency departments between 2010 and 2014. Interventions: None. Measurements: Demographic factors, severity of illness, and clinical outcomes among children receiving care in emergency departments with and without access to pediatric telemedicine, as well as a subcohort of children admitted from emergency departments before and after the implementation of telemedicine. Main Results: Five hundred eighty-two patients from 15 emergency departments with telemedicine and 524 patients from 60 emergency departments without telemedicine were transferred and admitted to the PICU. Children admitted from emergency departments using telemedicine were younger (5.6 vs 6.9 yr; p< 0.001) and less sick (Pediatric Risk of Mortality III score, 3.2 vs 4.0; p < 0.05) at admission to the PICU compared with children admitted from emergency departments without telemedicine. Among transfers from emergency departments that established telemedicine programs during the study period, children arrived significantly less sick (mean Pediatric Risk of Mortality III scores, 1.2 units lower; p = 0.03) after the implementation of telemedicine (n = 43) than before the implementation of telemedicine (n = 95). The observed-to-expected mortality ratios of posttelemedicine, pretelemedicine, and no-telemedicine cohorts were 0.81 (95% CI, 0.53-1.09), 1.07 (95% CI, 0.53-1.60), and 1.02 (95% CI, 0.71-1.33), respectively. Conclusions: The implementation of a telemedicine program designed to assist in the care of seriously ill children receiving care in referring emergency departments was associated with lower illness severity at admission to the PICU. This study contributes to the body of evidence that pediatric critical care telemedicine programs assist referring emergency departments in the care of critically ill children and could result in improved clinical outcomes.

Original languageEnglish (US)
Pages (from-to)516-521
Number of pages6
JournalPediatric Critical Care Medicine
Issue number6
StatePublished - Jun 1 2016



  • mortality
  • pediatric critical care
  • pediatric intensive care unit
  • pediatrics
  • severity of illness
  • telemedicine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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