Practice variability in the management of critical pertussis: a multicenter survey of pediatric intensivists in the Arabian Gulf Cooperation Council region

TL;DR

This study surveyed pediatric intensive care doctors in the GCC to assess how they manage severe pertussis cases, revealing significant variability in practices and resources.

Contribution

The study is the first to systematically evaluate practice variability and institutional capacity for critical pertussis management in the GCC region.

Findings

Most PICUs have access to mechanical ventilation, but extracorporeal membrane oxygenation is available in only 24.3% of centers.

There is wide variability in white blood cell thresholds for exchange transfusion and institutional protocols for pertussis management.

Physicians with more clinical experience had higher pertussis knowledge scores, indicating a link between experience and expertise.

Abstract

Critical pertussis continues to cause significant morbidity and mortality in infants necessitating pediatric intensive care. Despite advances in supportive care, knowledge gaps persist. This study aimed to examine institutional capacity, physician knowledge, and practice variability in managing critical pertussis among pediatric intensive care units (PICUs) across the Gulf Cooperation Council (GCC) countries.

A cross-sectional internet-based survey was distributed to PICU physicians across the six GCC countries between December 1, 2024, and January 31, 2025. Demographic information, clinical experience, diagnostic resources, and therapeutic approaches were collected. A multivariable generalized linear regression (Gamma) model identified factors associated with pertussis knowledge scores.

Among 185 respondents, almost 70% of participants were male, 62.7% were specialists or consultants, and around half (47%) were certified pediatric intensivists. Access to mechanical ventilation was almost universal (98.4%), yet extracorporeal membrane oxygenation was available in only 24.3% of centers. Polymerase chain reaction-based diagnosis was widely available, but more than one-third (36.2%) of participants reported a test turn-around-time of at least two days. A majority (66%) of physicians used exchange transfusion for hyperleukocytosis, but white blood cell thresholds varied widely. Institutional protocols were lacking in over 40% of centers. The average pertussis knowledge score was 9.52 out of 13 questions (SD ±1.72). Physician's clinical experience showed a strong and graded association with pertussis knowledge.

This study highlights the heterogeneity in pertussis management practices across the GCC PICUs, compounded by variability in resources and different institutional guidelines. Findings highlight the urgent need for standardized protocols to harmonize pertussis care.

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