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A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits.

Preissig CM, Rigby MR - Crit Care (2010)

Bottom Line: Strict glycemic control improves outcomes in some adult populations and may have similar effects in children.ICUs included a cross section of centers throughout the US.Considerable disparity exists between physician beliefs and actual practice habits regarding glycemic control among pediatric practitioners, with few centers reporting the use of any consistent standard approach to screening and management.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Center of Central Georgia, Department of Pediatrics, Division of Pediatric Critical Care Medicine, 777 Hemlock Street, Macon, Georgia, 31201, USA. preissig.catherine@mccg.org

ABSTRACT

Introduction: Hyperglycemia is common in critically ill patients and is associated with increased morbidity and mortality. Strict glycemic control improves outcomes in some adult populations and may have similar effects in children. While glycemic control has become standard care in adults, little is known regarding hyperglycemia management strategies used by pediatric critical care practitioners. We sought to assess both the beliefs and practice habits regarding glycemic control in pediatric intensive care units (ICUs) in the United States (US).

Methods: We surveyed 30 US pediatric ICUs from January to May 2009. Surveys were conducted by phone between the investigators and participating centers and consisted of a 22-point questionnaire devised to assess physician perceptions and center-specific management strategies regarding glycemic control.

Results: ICUs included a cross section of centers throughout the US. Fourteen out of 30 centers believe all critically ill hyperglycemic adults should be treated, while 3/30 believe all critically ill children should be treated. Twenty-nine of 30 believe some subsets of adults with hyperglycemia should be treated, while 20/30 believe some subsets of children should receive glycemic control. A total of 70%, 73%, 80%, 27%, and 40% of centers believe hyperglycemia adversely affects outcomes in cardiac, trauma, traumatic brain injury, general medical, and general surgical pediatric patients, respectively. However, only six centers use a standard, uniform approach to treat hyperglycemia at their institution. Sixty percent of centers believe hypoglycemia is more dangerous than hyperglycemia. Seventy percent listed fear of management-induced hypoglycemia as a barrier to glycemic control at their center.

Conclusions: Considerable disparity exists between physician beliefs and actual practice habits regarding glycemic control among pediatric practitioners, with few centers reporting the use of any consistent standard approach to screening and management. Physicians wishing to practice glycemic control in their critically ill pediatric patients may want to consider adopting center-wide uniform approaches to improve safety and efficacy of treatment.

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Related in: MedlinePlus

Pediatric intensivist actual glycemic control practice habits. Centers were queried regarding what percentage of practitioners always practice glycemic control, sometimes practice glycemic control, or never practice glycemic in all, most, some, few, and none of their hyperglycemic patients. Small ICU = <12 beds, Medium ICU = 12 to 30 beds, Large ICU = >30 beds. ICU = intensive care unit.
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Figure 1: Pediatric intensivist actual glycemic control practice habits. Centers were queried regarding what percentage of practitioners always practice glycemic control, sometimes practice glycemic control, or never practice glycemic in all, most, some, few, and none of their hyperglycemic patients. Small ICU = <12 beds, Medium ICU = 12 to 30 beds, Large ICU = >30 beds. ICU = intensive care unit.

Mentions: While few centers reported the use of any standard protocol for hyperglycemia management, we also assessed the use of glycemic control based on physician discretion at each center. When asked what percentage of hyperglycemic patients receive any treatment, either via a standard protocol used by all physicians or based on individual physician discretion, most centers (20/30, 67%) reported that likely only a minority (that is, 1 to 25%) of hyperglycemic patients receive any glycemic control. Figure 1 shows estimated numbers of physicians at each center that always, sometimes, or never treat critically ill children with hyperglycemia. Overall, no center reported that all of their physicians either always or never practice glycemic control. Approximately 35% of centers reported that most of their physicians always practice glycemic control, while 7% reported that most of their physicians never practice glycemic control. When broken down by ICU size, a proportionately higher number of small ICUs (<12 beds) were more likely to report that all or most of their physicians practice some type of glycemic control all or most of the time, and were more likely to report that few or none of their physicians never practice glycemic control (P < 0.05) (Figure 1). Half of the centers stated that for some of their physicians, the decision to treat hyperglycemia depended upon diagnosis, illness severity, and duration and severity of hyperglycemia. While most centers did not specify any agreed upon center-wide exclusions for glycemic management, three centers reported that they exclude infants and/or patients weighing <5 kg. Taken together, this data strongly indicate a large variation between glycemic control practices between pediatric ICUs, individual practitioners in any particular pediatric ICU, and at times even in the practice of any given physician.


A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits.

Preissig CM, Rigby MR - Crit Care (2010)

Pediatric intensivist actual glycemic control practice habits. Centers were queried regarding what percentage of practitioners always practice glycemic control, sometimes practice glycemic control, or never practice glycemic in all, most, some, few, and none of their hyperglycemic patients. Small ICU = <12 beds, Medium ICU = 12 to 30 beds, Large ICU = >30 beds. ICU = intensive care unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875525&req=5

Figure 1: Pediatric intensivist actual glycemic control practice habits. Centers were queried regarding what percentage of practitioners always practice glycemic control, sometimes practice glycemic control, or never practice glycemic in all, most, some, few, and none of their hyperglycemic patients. Small ICU = <12 beds, Medium ICU = 12 to 30 beds, Large ICU = >30 beds. ICU = intensive care unit.
Mentions: While few centers reported the use of any standard protocol for hyperglycemia management, we also assessed the use of glycemic control based on physician discretion at each center. When asked what percentage of hyperglycemic patients receive any treatment, either via a standard protocol used by all physicians or based on individual physician discretion, most centers (20/30, 67%) reported that likely only a minority (that is, 1 to 25%) of hyperglycemic patients receive any glycemic control. Figure 1 shows estimated numbers of physicians at each center that always, sometimes, or never treat critically ill children with hyperglycemia. Overall, no center reported that all of their physicians either always or never practice glycemic control. Approximately 35% of centers reported that most of their physicians always practice glycemic control, while 7% reported that most of their physicians never practice glycemic control. When broken down by ICU size, a proportionately higher number of small ICUs (<12 beds) were more likely to report that all or most of their physicians practice some type of glycemic control all or most of the time, and were more likely to report that few or none of their physicians never practice glycemic control (P < 0.05) (Figure 1). Half of the centers stated that for some of their physicians, the decision to treat hyperglycemia depended upon diagnosis, illness severity, and duration and severity of hyperglycemia. While most centers did not specify any agreed upon center-wide exclusions for glycemic management, three centers reported that they exclude infants and/or patients weighing <5 kg. Taken together, this data strongly indicate a large variation between glycemic control practices between pediatric ICUs, individual practitioners in any particular pediatric ICU, and at times even in the practice of any given physician.

Bottom Line: Strict glycemic control improves outcomes in some adult populations and may have similar effects in children.ICUs included a cross section of centers throughout the US.Considerable disparity exists between physician beliefs and actual practice habits regarding glycemic control among pediatric practitioners, with few centers reporting the use of any consistent standard approach to screening and management.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Center of Central Georgia, Department of Pediatrics, Division of Pediatric Critical Care Medicine, 777 Hemlock Street, Macon, Georgia, 31201, USA. preissig.catherine@mccg.org

ABSTRACT

Introduction: Hyperglycemia is common in critically ill patients and is associated with increased morbidity and mortality. Strict glycemic control improves outcomes in some adult populations and may have similar effects in children. While glycemic control has become standard care in adults, little is known regarding hyperglycemia management strategies used by pediatric critical care practitioners. We sought to assess both the beliefs and practice habits regarding glycemic control in pediatric intensive care units (ICUs) in the United States (US).

Methods: We surveyed 30 US pediatric ICUs from January to May 2009. Surveys were conducted by phone between the investigators and participating centers and consisted of a 22-point questionnaire devised to assess physician perceptions and center-specific management strategies regarding glycemic control.

Results: ICUs included a cross section of centers throughout the US. Fourteen out of 30 centers believe all critically ill hyperglycemic adults should be treated, while 3/30 believe all critically ill children should be treated. Twenty-nine of 30 believe some subsets of adults with hyperglycemia should be treated, while 20/30 believe some subsets of children should receive glycemic control. A total of 70%, 73%, 80%, 27%, and 40% of centers believe hyperglycemia adversely affects outcomes in cardiac, trauma, traumatic brain injury, general medical, and general surgical pediatric patients, respectively. However, only six centers use a standard, uniform approach to treat hyperglycemia at their institution. Sixty percent of centers believe hypoglycemia is more dangerous than hyperglycemia. Seventy percent listed fear of management-induced hypoglycemia as a barrier to glycemic control at their center.

Conclusions: Considerable disparity exists between physician beliefs and actual practice habits regarding glycemic control among pediatric practitioners, with few centers reporting the use of any consistent standard approach to screening and management. Physicians wishing to practice glycemic control in their critically ill pediatric patients may want to consider adopting center-wide uniform approaches to improve safety and efficacy of treatment.

Show MeSH
Related in: MedlinePlus