Building Clinical Artificial Intelligence at the PICU Bedside: Recognizing the Clinician-Builder.

Several of the highest-value problems in critical care-synthesizing fragmented bedside data, surfacing the tacit heuristics of experienced clinicians, generating accurate family-facing explanations, and decision support-are too specialized, too local, and too embedded in uncodified practice to specify from outside the unit; the market they represent is often too small to repay commercial development. This commentary argues for recognizing a missing translational figure: the clinician-builder-a frontline clinician who identifies workflow failures and prototypes tools to address them, much as the clinician-scientist did for molecular medicine. Because a prototype is not a product, the clinician-builder co-develops intended use, evidence, and governance with institutional artificial intelligence (AI) centers. Pediatric intensive care should not be the last setting to receive clinical AI, but among the first where it is judged-and a blueprint for other specialties.