Location, location, location: regionalization and outcome in pediatric critical care.

This article briefly reviews some of the background, recent studies, and unanswered questions related to regionalization of critical care services for children. Evidence and arguments in support of centralized services for critically ill children are increasing. Early studies suggested that organized systems of care improve outcomes. More recently, investigators have examined tertiary pediatric critical care and specific components of tertiary care. More recent studies have provided additional evidence supporting regionalization and documenting its effects. Unfortunately, a growing body of evidence suggests that many hospitalized critically ill children with fatal outcomes in the United States never received the highest level of care available.