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Functional outcome of children treated in intensive care unit
Julije Mestrovic1, Branka Polic, Marija Mestrovic
1Department of Pediatrics, Split University Hospital, School of Medicine, University of Split, Split, Croatia. julije.mestrovic@st.t-com.hr
Insights
The functional status of children in pediatric intensive care units (PICUs) is significantly impacted by pre-existing conditions. Children with neurodevelopmental disabilities experienced worse outcomes, highlighting the importance of considering comorbidity in PICU care.
Area of Science:
- Pediatric Intensive Care
- Clinical Outcomes Research
- Healthcare Quality Assessment
Background:
- Patient outcomes in pediatric intensive care units (PICUs) are influenced by illness severity and pre-existing comorbid conditions.
- Understanding the impact of chronic diseases on functional status is crucial for effective PICU management.
Purpose of the Study:
- To evaluate the outcomes of patients in a PICU, with a specific focus on children with chronic diseases.
- To assess the impact of preadmission comorbid status on functional outcomes in pediatric patients.
Main Methods:
- Prospective data collection from 449 patients at Split University Hospital's PICU.
- Utilized the Pediatric Overall Performance Category (POPC) scale to assess functional performance at preadmission and discharge.
- Categorized patients into groups: neurodevelopmental disabilities, other chronic diseases, and no chronic disease.
Main Results:
- Discharge functional status was significantly correlated with preadmission status and predicted mortality.
- Children with neurodevelopmental disabilities presented with worse baseline functional scores.
- This group showed significantly less deterioration in functional morbidity at discharge compared to other groups.
Conclusions:
- The POPC scale is a practical and accurate tool for evaluating healthcare quality in diverse PICU populations.
- Comorbidity, particularly neurodevelopmental disabilities, markedly influences functional status in pediatric PICU patients.
- The preadmission status of children with neurodevelopmental disabilities impacts their observed functional changes during PICU stay.
Objective:
Outcome of patients is determined not only by severity of illness index, but also by the impact of patients' preadmission comorbid status. Therefore, we aimed at evaluating the outcome of patients treated in a pediatric intensive care unit, with special focus on the group of children with chronic diseases.
Methods:
Data were obtained prospectively and outcome was assessed according to the Pediatric Overall Performance Category scale for 449 patients in a pediatric intensive care unit of the Split University Hospital. Functional performance was assessed as the preadmission score and the discharge score in patients with neurodevelopmental disabilities, patients with other chronic diseases, and those without chronic disease.
Results:
The discharge functional status was significantly dependent on the preadmission functional status and on predicted mortality. Children with neurodevelopmental disabilities had the significantly worse baseline score and the significantly smaller deterioration of functional morbidity at discharge compared to children with no chronic disease and children with other chronic diseases.
Conclusions:
The Pediatric Overall Performance Category scale has proved its applicability in a small intensive care unit, with a heterogeneous population of patients. It should therefore be considered for regular evaluation of health care quality, as a simple and accurate tool. As opposed to other patients, functional status of children with neurodevelopmental disabilities was markedly influenced by their comorbidity. Their preadmission status was worse than the status of other children, and hence could not significantly deteriorate at discharge.
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