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Quality of care and mortality in pediatric intensive care units.

To the Editor. —The report by Dr Pollack and colleagues 1 on the impact of residents and critical care specialists on outcome in pediatrie ICUs strengthens the arguments for sub-specialization in this area. However, serious flaws in the analysis limit the extrapolation of their conclusions beyond the few institutions studied. On one hand, we are not surprised with the finding that the presence of intensivists was associated with improved survival. Pollack's previous work 2 supports this same conclusion. Indeed, guidelines developed by the Pediatrie Section of the Society of Critical Care Medicine and the Committee on Hospital Care of the American Academy of Pediatrics provide that medical direction be delivered by a certified intensivist and that multiple specialists, including intensivists, be available on short notice. 3 A pediatrie ICU without critical care specialists is analogous to a cardiac surgery operating room without an appropriately trained surgeon. We question whether the