Karen Choong1, Douglas Fraser2,3, Samah Al-Harbi4, Asm Borham1, Jill Cameron5,6, Saoirse Cameron2,3, Ji Cheng1, Heather Clark1, Tim Doherty2,3, Nora Fayed7, Jan-Willem Gorter1, Margaret Herridge5, Mary Khetani7, Kusum Menon8, Jamie Seabrook2,3, Racquel Simpson1, Lehana Thabane1. 1. Department of Pediatrics, Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 2. Department of Pediatrics, Western University, London, ON, Canada. 3. Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada. 4. Department of Pediatric Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia. 5. Departments of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada. 6. Department of Medicine, University of Toronto, Toronto, ON, Canada. 7. School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada. 8. Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL.
Abstract
OBJECTIVES: To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness. DESIGN: Prospective observational longitudinal cohort study. SETTING: Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences. PATIENTS: Children 12 months to 17 years old, admitted to PICU for at least 48 hours with one or more organ dysfunction, were eligible. Patients not expected to survive, direct transfers from neonatal ICU and patients in whom long-term follow-up would not be able to be conducted, were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was functional outcome up to 6 months post PICU discharge, measured using the Pediatric Evaluation of Disabilities Inventory Computer Adaptive Test. Secondary outcomes included predictors of unfavorable functional outcome, caregiver stress, health-related quality-of-life, and clinical outcomes such as mortality, length of stay, and PICU-acquired complications. One hundred eighty-two patients were enrolled; 78 children (43.6%) had functional limitations at baseline and 143 (81.5%) experienced functional deterioration following critical illness. Ninety-two (67.1%) demonstrated some functional recovery by 6 months. Higher baseline function and a neurologic insult at PICU admission were the most significant predictors of functional deterioration. Higher baseline function and increasing age were associated with slower functional recovery. Different factors affect the domains of functioning differently. Preexisting comorbidities and iatrogenic PICU-acquired morbidities were associated with persistent requirement for caregiver support (responsibility function) at 6 months. The degree of functional deterioration after critical illness was a significant predictor of increased hospital length of stay. CONCLUSIONS: This study provides new information regarding functional outcomes and the factors that influence meaningful aspects of functioning in critically ill children. Identifying patients at greatest risk and modifiable targets for improvement in PICU care guides us in developing strategies to improve functional outcomes and tailor to the rehabilitation needs of these patients and their families.
OBJECTIVES: To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness. DESIGN: Prospective observational longitudinal cohort study. SETTING: Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences. PATIENTS: Children 12 months to 17 years old, admitted to PICU for at least 48 hours with one or more organ dysfunction, were eligible. Patients not expected to survive, direct transfers from neonatal ICU and patients in whom long-term follow-up would not be able to be conducted, were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was functional outcome up to 6 months post PICU discharge, measured using the Pediatric Evaluation of Disabilities Inventory Computer Adaptive Test. Secondary outcomes included predictors of unfavorable functional outcome, caregiver stress, health-related quality-of-life, and clinical outcomes such as mortality, length of stay, and PICU-acquired complications. One hundred eighty-two patients were enrolled; 78 children (43.6%) had functional limitations at baseline and 143 (81.5%) experienced functional deterioration following critical illness. Ninety-two (67.1%) demonstrated some functional recovery by 6 months. Higher baseline function and a neurologic insult at PICU admission were the most significant predictors of functional deterioration. Higher baseline function and increasing age were associated with slower functional recovery. Different factors affect the domains of functioning differently. Preexisting comorbidities and iatrogenic PICU-acquired morbidities were associated with persistent requirement for caregiver support (responsibility function) at 6 months. The degree of functional deterioration after critical illness was a significant predictor of increased hospital length of stay. CONCLUSIONS: This study provides new information regarding functional outcomes and the factors that influence meaningful aspects of functioning in critically ill children. Identifying patients at greatest risk and modifiable targets for improvement in PICU care guides us in developing strategies to improve functional outcomes and tailor to the rehabilitation needs of these patients and their families.
Authors: Cydni N Williams; Mary E Hartman; Kristin P Guilliams; Rejean M Guerriero; Juan A Piantino; Christopher C Bosworth; Skyler S Leonard; Kathryn Bradbury; Amanda Wagner; Trevor A Hall Journal: Curr Treat Options Neurol Date: 2019-09-27 Impact factor: 3.598
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Authors: Adrian F Bulfon; Hakem L Alomani; Natalie Anton; Brooke T Comrie; Bram Rochwerg; Sorina A Stef; Lehana Thabane; Thuva Vanniyasingam; Karen Choong Journal: J Pediatr Intensive Care Date: 2019-06-19
Authors: Jerry J Zimmerman; Russell Banks; Robert A Berg; Athena Zuppa; Christopher J Newth; David Wessel; Murray M Pollack; Kathleen L Meert; Mark W Hall; Michael Quasney; Anil Sapru; Joseph A Carcillo; Patrick S McQuillen; Peter M Mourani; Hector Wong; Ranjit S Chima; Richard Holubkov; Whitney Coleman; Samuel Sorenson; James W Varni; Julie McGalliard; Wren Haaland; Kathryn Whitlock; J Michael Dean; Ron W Reeder Journal: Crit Care Med Date: 2020-03 Impact factor: 7.598
Authors: Daniël Bossen; Rosa M de Boer; Hendrika Knoester; Jolanda M Maaskant; Marike van der Schaaf; Mattijs W Alsem; Reinoud J B J Gemke; Job B M van Woensel; Jaap Oosterlaan; Raoul H H Engelbert Journal: Crit Care Explor Date: 2021-06-15