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Functional recovery following critical illness in children: the "wee-cover" pilot study
Karen Choong1, Samah Al-Harbi, Katie Siu
11Department of Pediatrics, Critical Care, Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 2Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. 3Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. 4Department of Pediatrics, and Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. 5CanChild Centre for Childhood Disability, McMaster University, Hamilton, Ontario, Canada. 6Department of Occupational Therapy, Colorado State University, Fort Collins, CO.
Insights
This pilot study shows that a longitudinal study on functional recovery in critically ill children is feasible. Initial findings suggest baseline health and illness severity impact recovery trajectories.
Area of Science:
- Pediatric critical care medicine
- Functional recovery research
- Longitudinal study design
Background:
- Critically ill children often experience long-term functional impairments.
- Understanding functional recovery is crucial for improving pediatric intensive care outcomes.
- Predictors of impaired recovery require further investigation.
Purpose of the Study:
- To assess the feasibility of a longitudinal prospective study in critically ill children.
- To identify potential predictors of functional recovery post-pediatric intensive care unit (PICU) admission.
- To inform the design of a larger multicenter study on pediatric functional recovery.
Main Methods:
- Prospective pilot study conducted at a single-center pediatric intensive care unit (PICU).
- Eligible participants: children aged 1-17 years with organ dysfunction or mobility limitations.
- Feasibility assessed by screening, enrollment, and procedure execution; functional status measured using validated tools.
Main Results:
- The study successfully demonstrated feasibility, with high consent (85%) and follow-up rates (93% at 3 months, 71% at 6 months).
- Thirty-three patients were enrolled, and study procedures were executed.
- Functional status generally declined post-critical illness, with preliminary evidence suggesting baseline health and illness severity influence recovery.
Conclusions:
- Longitudinal research is essential for understanding pediatric critical illness recovery.
- This pilot study successfully informed the methodology for a larger multicenter investigation.
- Factors such as baseline health and illness severity appear to be key determinants of functional recovery trajectories in children.
Objective:
To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children.
Design:
Prospective pilot study.
Setting:
Single-center PICU at McMaster Children's Hospital, Hamilton, Canada.
Patients:
Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed rest during the first 48 hours of PICU admission, and a minimum 48-hour PICU length of stay, were eligible. Patients transferred from a neonatal ICU prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study, were excluded.
Interventions:
None.
Measurements And Main Results:
The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity, and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory and the Participation and Environment Measure for Children and Youth. Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, and follow-up rates were 93% at 3 months and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status and severity of illness.
Conclusion:
Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multicenter study evaluating functional recovery in this population.
