I'd say disease specific. However for something entirely new in onset, I'm struggling to come up with a condition that makes sense once past the age of 21. Depending on the center, technical expertise in ECMO might be most concentrated in the PICU faculty and make it appropriate for a pediatric intensivist to be heavily, heavily involved.
Pediatric surgical subspecialists may have a greater extended age range than those of us who did a pediatric residency. I've seen a man in his 40's get diagnosed with a Aortic Coarctation after an episode of chest pain where the adult CT surgeons referred to the Peds CT surgeons. Obviously this is a chronic condition that got missed and wasn't a critical coarct, but again the technical expertise lies with the pediatric subspecialist.
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When does Pediatrics End?
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