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Functional Outcomes and Physical Impairments in Pediatric Critical Care Survivors: A Scoping Review
Chengsi Ong1, Jan Hau Lee, Melvin K S Leow
11Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 2Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, Singapore. 3Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore. 4Office of Clinical Sciences, Duke-NUS School of Medicine, Singapore, Singapore. 5Clinical Nutrition Research Centre, A*STAR-NUHS, Centre for Translational Medicine, Singapore, Singapore. 6Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore. 7Centre for Human Health and Performance, University College London, London, United Kingdom. 8Institute of Sport, Exercise and Health, University College Hospitals London, London, United Kingdom. 9Division of Critical Care, University College Hospitals London, London, United Kingdom. 10Division of Respiratory and Critical Care, National University Hospital, Singapore, Singapore.
Insights
Pediatric critical care survivors often face long-term physical impairments, with rates varying by measurement timing and tools. Further research is needed to understand these functional outcomes.
Area of Science:
- Pediatric critical care
- Rehabilitation medicine
- Functional outcomes
Background:
- Increasing survival rates in pediatric critical illness necessitate understanding long-term physical sequelae.
- Limited knowledge exists regarding the prevalence and nature of physical impairments in these survivors.
Purpose of the Study:
- To critically appraise literature on functional outcome measurement tools.
- To determine the prevalence of physical impairments in pediatric critical care survivors.
- To identify risk factors associated with these impairments.
Main Methods:
- Scoping review of literature.
- Searched PubMed, Embase, and CINAHL databases.
- Included studies on children (0-18 years) admitted to the pediatric intensive care unit (PICU).
Main Results:
- Utilized three global assessment tools and eight multidimensional measures.
- Reported functional impairment rates from 10% to 36% at discharge and 10% to 13% long-term.
- Identified illness severity, organ dysfunction, ICU stay length, and younger age as risk factors.
Conclusions:
- Physical impairments can be persistent in pediatric critical care survivors.
- Variability in measurement tools and timing limits generalizability.
- Standardized, multi-time-point measures are crucial for comprehensive assessment.
Objective:
Although more children are surviving critical illness, little is known about long-term physical impairment. This scoping review aims to critically appraise existing literature on functional outcome measurement tools, prevalence, and risk factors for physical impairments in pediatric critical care survivors.
Data Sources:
PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature, using a combination of MeSH terms and keywords (critical illness, intensive care, and functional outcomes/status).
Study Selection:
All human studies reporting functional outcomes in children 0-18 years old admitted to the PICU. Non-English language, adult and preterm infant studies were excluded.
Data Synthesis:
Three global assessment tools and eight multidimensional measures were used to measure functional outcome in pediatric survivors of critical illness. Rates of acquired functional impairment in a general pediatric intensive care cohort ranged from 10% to 36% at discharge and 10% to 13% after more than 2 years. Risk factors for acquired functional impairment include illness severity, the presence of organ dysfunction, length of ICU stay, and younger age. There is some evidence that physical impairment may be more severe and persistent than psychosocial components.
Conclusions:
Functional impairment may be persistent in pediatric survivors of critical care. Unfortunately, studies varied largely in measurement timing and tools used. The lack of differentiation between impairment in different functional domains limited the generalizability of data. Further studies using a combination of standardized measures at various time points of the disease process can help establish more comprehensive rates of physical impairment.
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