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Normal Baseline Function Is Associated With Delayed Rehabilitation in Critically Ill Children

Shinya Miura1, Beth Wieczorek2, Hallie Lenker3

  • 1Department of Pediatric Intensive Care, Saitama Children's Medical Center, Saitama, Japan.

Journal of Intensive Care Medicine
|January 24, 2018
PubMed

Insights

Early rehabilitation in pediatric intensive care units (PICUs) is crucial. Critically ill children with baseline motor impairment or higher Pediatric Risk of Mortality scores were more likely to receive early physical therapist (PT) consultation.

Area of Science:

  • Pediatric intensive care
  • Rehabilitation medicine
  • Quality improvement initiatives

Background:

  • Early mobilization in adult ICUs improves outcomes.
  • Early mobilization in PICUs is safe but PT consultation may be delayed.
  • Factors influencing timely PT involvement in critically ill children are unknown.

Purpose of the Study:

  • Identify patient-level factors for early physical therapist (PT) consultation in a tertiary care PICU.
  • Inform the implementation of a multicomponent early mobilization program.
  • Characterize predictors of acute rehabilitation initiation.

Main Methods:

  • Retrospective analysis of data from the PICU Up! Quality Improvement Initiative.
  • Defined early rehabilitation as PT consultation within 3 days of PICU admission.
  • Used logistic regression to analyze predictive factors for early rehabilitation in 100 patients.

Main Results:

  • 54% of patients received early rehabilitation.
  • Higher Pediatric Risk of Mortality (PRISM) scores and baseline motor impairment were associated with early rehabilitation.
  • Baseline motor impairment (aOR=5.36) and higher PRISM scores (aOR=1.17) independently predicted early PT consultation.

Conclusions:

  • Critically ill children with normal baseline function or lower acuity are less likely to receive early rehabilitation.
  • Baseline motor impairment and higher PRISM scores are key predictors for early PT consultation.
  • Streamlined criteria for PT consultation are needed to ensure all critically ill children receive timely rehabilitation.
Abstract

Keywords:
childcritical careearly mobilizationpediatricspostoperative carepostoperative complicationsprogram developmentrisk factor

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