Practice Variability in the Management of Critical Pertussis: A Multicenter Survey of Pediatric Intensivists in the Arabian Gulf Cooperation Council Region

Mohammad Alghounaim^1*Mohamad-Hani Temsah^2,3AbdulRahman AlDaithan⁴Manu S Sundaram^5,6Amal Al Daylami⁷Musaab Ramsi⁸Saif Awlad Thani⁹Yasser Kazzaz^10,11,12Abdulla Alfraij¹³

• ¹Department of Pediatrics, Amiri Hospital, Kuwait City, Kuwait
• ²Pediatric Intensive Care Unit, Pediatric Department, King Saud University College of Medicine, Riyadh, Saudi Arabia
• ³Evidence-Based Healthcare and Knowledge Translation Research Chair, Family Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
• ⁴Pediatric Intensive care Unit, Pediatric Department, Farwaniya Hospital, Farwaniya, Kuwait
• ⁵Pediatric Intensive Care Unit, Sidra Medicine, Ar-Rayyan, Qatar
• ⁶Weill Cornell Medicine - Qatar, Doha, Qatar
• ⁷Pediatric Intensive Care Unit, Government Hospital, Manamah, Bahrain
• ⁸Pediatric Critical Care Unit, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
• ⁹Pediatric Intensive Care Unit, The Royal Hospital, Muscat, Oman
• ¹⁰King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
• ¹¹King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
• ¹²Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
• ¹³Pediatric Intensive Care Unit, Ahmadi Hospital, Ahmadi, Kuwait

Background: 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. Methods: 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. Results: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. Conclusions: 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.