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Long-term outcome of children with high tetraplegia and ventilator dependence
Virginia Simson Nelson1, Pamela J Dixon, Seth A Warschausky
1Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan 48108-0744, USA. vsnelson@umich.edu
Insights
This study followed 49 children with spinal cord injuries (SCI) and long-term mechanical ventilation (LTMV), finding they achieved good medical and psychological outcomes. Predictors of quality of life were also examined in these pediatric SCI patients.
Area of Science:
- Pediatric Rehabilitation Medicine
- Spinal Cord Injury Research
- Mechanical Ventilation Outcomes
Background:
- Long-term follow-up of children with spinal cord injuries (SCI) and ventilator dependence is crucial for understanding outcomes.
- University of Michigan C.S. Mott Children's Hospital has a cohort of 49 such children since 1978.
- Previous studies have gathered prospective data on quality of life and outcomes.
Purpose of the Study:
- To determine physical outcomes for children with SCI and long-term mechanical ventilation (LTMV).
- To identify predictors of quality of life in pediatric SCI patients with LTMV.
- To compare outcomes of individuals on home ventilation with SCI to matched control groups.
Main Methods:
- Prospective data collection and retrospective chart reviews were used.
- The study included all 49 children with SCI and LTMV followed at the institution from 1978 to 2003.
- Data included age at injury, injury level (tetraplegia/paraplegia), and ASIA impairment scale.
Main Results:
- Of 49 children, 25 are alive, 16 have died post-discharge, and 8 were lost to follow-up.
- Injury patterns included high tetraplegia (40), low tetraplegia (7), paraplegia (2), and ASIA A (42) or D (7) impairments.
- All children were discharged to home or foster care settings.
Conclusions:
- Children with SCI and LTMV demonstrate remarkably good medical and psychological outcomes.
- Further research compares these children to matched control groups to assess quality of life.
- The study highlights the importance of continued support and care for pediatric SCI patients on ventilators.
Background/Objectives:
Since 1978, 350 children with ventilator dependence, including 49 with spinal cord injuries (SCIs), have been followed at the University of Michigan C.S. Mott Children's Hospital. Some data were kept on these children prospectively and included in various studies relating to their outcomes and quality of life. This study was designed to determine physical outcomes of children with SCI and long-term mechanical ventilation (LTMV) and to determine predictors of quality of life for children with SCI and LTMV.
Methods:
Prospective data collection and retrospective chart reviews were conducted for all 49 children with SCI and LTMV followed at the University of Michigan C.S. Mott Children's Hospital from 1978 to 2003.
Results:
Of the 49 children with SCI and LTMV, 25 are alive, 16 have died following initial hospital discharge, and 8 have been lost to follow-up. Age at injury was under 5 years for 15, 5 to 9 years for 12, 10 to 14 years for 9, and over 14 years for 13. Forty had high tetraplegia, 7 had low tetraplegia, and 2 had paraplegia. Forty-two had ASIA A injuries, and 7 had ASIA D. All were discharged to their own homes or foster care.
Conclusion:
Our research studies of children with ventilator dependence with and without history of SCI have examined daily activities, perceptions of their quality of life, and their health and medical complications. This study compares individuals 16 years of age and older with matched control groups of those with tetraplegic SCI who do not use ventilators and those with other diagnoses who use home ventilation. Overall, these children have done remarkably well medically and psychologically.
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