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Children's self-reported quality of life after intensive care treatment
Gillian A Colville1, Christine M Pierce
1Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK. gcolvill@sgul.ac.uk
Insights
Pediatric Quality of Life Inventory scores in children after intensive care improved over time, becoming comparable to community samples by one year. However, physical functioning remained lower, and post-traumatic stress symptoms were linked to lower quality of life.
Area of Science:
- Pediatric intensive care outcomes
- Child health and quality of life
Background:
- Previous studies focused on parental/clinician reports of pediatric quality of life post-intensive care.
- There is a need to understand children's own perspectives on their health outcomes after pediatric intensive care unit (PICU) admission.
Purpose of the Study:
- To determine children's self-reported quality of life after PICU treatment.
- To assess changes in quality of life over time and identify factors influencing it.
Main Methods:
- Prospective cohort study of 97 children (aged >7 years) admitted to a tertiary PICU.
- Children completed the Pediatric Quality of Life Inventory (PedsQL) and a post-traumatic stress screener at 3 months and 1 year post-discharge.
Main Results:
- Total PedsQL scores at 1 year were comparable to community samples, improving from lower scores at 3 months.
- Physical functioning subscale scores remained lower than community samples but improved significantly from 3 months to 1 year.
- Higher emotional functioning was reported by elective surgery patients, and post-traumatic stress symptoms were negatively associated with quality of life at 1 year.
Conclusions:
- The self-report Pediatric Quality of Life Inventory is a feasible and sensitive tool for assessing health-related quality of life in PICU survivors.
- Children's own views reveal significant improvements in quality of life post-PICU, though physical functioning may take longer to recover.
- Addressing post-traumatic stress is crucial for optimizing the long-term quality of life for pediatric intensive care survivors.
Objectives:
A number of studies have reported on parental/clinician reports of children's quality of life after intensive care treatment. The aim of this study was to establish children's own views of their outcome. [corrected].
Design:
Prospective cohort study. [corrected].
Setting:
Twenty-one bed PICU in a tertiary Children's Hospital.
Patients:
Ninety-seven children aged over 7 yr, with no preexisting learning difficulties, consecutively admitted to PICU over an 18 month period
Interventions:
Patients completed the Pediatric Quality of Life Inventory and a post-traumatic stress screener, at 3 months and again at 1 year (n = 72) after discharge from PICU.
Measurements And Main Results:
At 3 months post-discharge, the mean total Pediatric Quality of Life Inventory score reported by the PICU group was lower than that reported in the literature for a non-clinical community sample (PICU mean = 79.1 vs community mean = 83.9, p = 0.003), but by 1 year, they were comparable (82.2, p = 0.388). The mean physical functioning subscale score remained lower (PICU mean=81.6 vs. community mean=88.5, p = 0.01), but improved significantly from 73.4 at 3 months (p = 0.001).Sub-group analyses revealed that the elective group reported higher emotional functioning than the community sample (91.0, p=0.005 at 3 months and 88.2, p = 0.038 at 1 year vs community mean=78.5), and made significant gains in social functioning between timepoints (79.1 to 91.4, p = 0.015).Finally, although total PedsQL scores at 1 year were not associated with measures of severity of illness during admission, they were significantly negatively associated with concurrent post-traumatic stress symptom scores (r = -0.40, p = 0.001).
Conclusions:
The self-report version of the Pediatric Quality of Life Inventory proved to be a feasible and sensitive tool for assessing health related quality of life in this group of PICU survivors.
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