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Functional Recovery in Critically Ill Children, the "WeeCover" Multicenter Study
Karen Choong1, Douglas Fraser2,3, Samah Al-Harbi4
1Department of Pediatrics, Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Insights
Most critically ill children experience functional deterioration, but many show recovery within six months. Higher baseline function and neurological injury predict deterioration, while age and baseline function influence recovery speed.
Area of Science:
- Pediatric Critical Care Medicine
- Rehabilitation Medicine
- Pediatric Health Outcomes
Background:
- Critical illness in children can lead to significant functional impairments.
- Understanding functional outcomes and recovery trajectories is crucial for pediatric intensive care unit (PICU) survivors.
Purpose of the Study:
- To evaluate functional outcomes in children after critical illness.
- To identify predictors of unfavorable functional outcomes in this population.
Main Methods:
- Prospective observational longitudinal cohort study conducted in two Canadian tertiary care PICUs.
- Enrolled children aged 12 months to 17 years with organ dysfunction requiring PICU admission for at least 48 hours.
- Assessed functional outcomes using the Pediatric Evaluation of Disabilities Inventory Computer Adaptive Test up to 6 months post-PICU discharge.
Main Results:
- 81.5% of enrolled children experienced functional deterioration following critical illness.
- Higher baseline function and neurological insult at PICU admission predicted functional deterioration.
- 67.1% showed some functional recovery by 6 months; higher baseline function and increasing age were associated with slower recovery.
- Preexisting comorbidities and PICU-acquired morbidities predicted persistent caregiver support needs.
Conclusions:
- Critically ill children frequently experience functional deterioration, with varying recovery patterns.
- Identifying predictors of poor outcomes can guide targeted interventions and rehabilitation strategies.
- This study highlights the need for comprehensive follow-up care to improve long-term functional status in pediatric PICU survivors.
Objectives:
To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness.
Design:
Prospective observational longitudinal cohort study.
Setting:
Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences.
Patients:
Children 12 months to 17 years old, admitted to PICU for at least 48 hours with one or more organ dysfunction, were eligible. Patients not expected to survive, direct transfers from neonatal ICU and patients in whom long-term follow-up would not be able to be conducted, were excluded.
Interventions:
None.
Measurements And Main Results:
The primary endpoint was functional outcome up to 6 months post PICU discharge, measured using the Pediatric Evaluation of Disabilities Inventory Computer Adaptive Test. Secondary outcomes included predictors of unfavorable functional outcome, caregiver stress, health-related quality-of-life, and clinical outcomes such as mortality, length of stay, and PICU-acquired complications. One hundred eighty-two patients were enrolled; 78 children (43.6%) had functional limitations at baseline and 143 (81.5%) experienced functional deterioration following critical illness. Ninety-two (67.1%) demonstrated some functional recovery by 6 months. Higher baseline function and a neurologic insult at PICU admission were the most significant predictors of functional deterioration. Higher baseline function and increasing age were associated with slower functional recovery. Different factors affect the domains of functioning differently. Preexisting comorbidities and iatrogenic PICU-acquired morbidities were associated with persistent requirement for caregiver support (responsibility function) at 6 months. The degree of functional deterioration after critical illness was a significant predictor of increased hospital length of stay.
Conclusions:
This study provides new information regarding functional outcomes and the factors that influence meaningful aspects of functioning in critically ill children. Identifying patients at greatest risk and modifiable targets for improvement in PICU care guides us in developing strategies to improve functional outcomes and tailor to the rehabilitation needs of these patients and their families.