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Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our
P Madurga Revilla1, J López Pisón2, P Samper Villagrasa3
1Unidad de Cuidados Intensivos Pediátrica, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
Insights
Critically ill children with neurological conditions often experience functional decline post-discharge, particularly those without prior neurological issues. Improved neuromonitoring and neuroprotection are vital for better outcomes in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Pediatric neurology
- Neurocritical care
Background:
- Neurological diseases are a major cause of morbidity and mortality in pediatric intensive care units (PICUs).
- Understanding the functional progression of these critically ill children is essential for improving care.
Purpose of the Study:
- To analyze the functional progression of children with critical neurological conditions admitted to the PICU.
- To compare current outcomes with historical data and international studies.
Main Methods:
- Retrospective descriptive study of 266 children admitted to PICU between 2012-2014.
- Assessed functional prognosis at PICU discharge and one year using Pediatric Cerebral and Overall Performance Category (PCPC-POPC) and Functional Status Scale (FSS).
Main Results:
- Mortality rate was 3%; predictive models (PRISM-III, PIM2) lacked predictive ability.
- 30% showed functional worsening at discharge (POPC), 15% (PCPC), and 5% (FSS).
- Mortality and neurocritical functional impairment were lower compared to previous data and the PANGEA study.
Conclusions:
- A significant percentage of critically ill children, especially those without underlying neurological diseases, experience lasting functional impairment.
- Neuromonitoring, neuroprotection, and functional outcome evaluation are crucial for enhancing pediatric neurocritical care.
Introduction:
Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions.
Material And Methods:
Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study.
Results:
A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively).
Conclusions:
Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care.
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