Application of Telemedicine Technology to Facilitate Diagnosis of Pediatric Postintensive Care Syndrome
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Published on: January 20, 2019
Smitha R Mathew1, Josephine Elia1, Scott Penfil2
1Nemours/Alfred I. duPont Hospital for Children, Wilmington, Deleware, USA.
Insights
Postintensive care syndrome (PICS) in children is linked to age and the number of procedures. Telemedicine follow-up did not improve completion rates compared to traditional clinics.
Area of Science:
- Pediatric intensive care
- Telemedicine
- Psychiatry
Background:
- Postintensive care syndrome (PICS) is established in adults but understudied in pediatrics.
- Pediatric intensive care unit (PICU) survivors may experience long-term functional impairments.
- Telemedicine offers a potential solution for accessible follow-up care.
Purpose of the Study:
- To characterize PICS in pediatric patients using a telemedicine platform.
- To identify risk factors associated with PICS development and functional impairment.
- To evaluate the effectiveness of virtual follow-up clinics for PICS assessment.
Main Methods:
- Prospective single-center study of pediatric ICU patients aged 4-17.
- Utilized a secure telehealth platform for administering the Weiss Functional Impairment Rating Scale (WFIRS) at 1 week, 1 month, and 3 months postdischarge.
- Patients with elevated WFIRS scores were referred for psychiatric evaluation.
Main Results:
- Fifty patients were enrolled; risk factors included procedural interventions, PICU length of stay, and specialty consults.
- Age was the only significant factor associated with PICS development in univariate analysis.
- Higher WFIRS score changes correlated with more procedures, specialists involved, and psychiatric referrals. Telemedicine follow-up completion rate was 34%.
Conclusions:
- Age is associated with PICS development in children.
- The number of procedures, specialists, and psychiatric referrals correlate with functional impairment changes.
- Telemedicine did not improve follow-up rates compared to outpatient studies for PICS characterization.
Abstract:
Postintensive care syndrome (PICS) is well-defined in the adult literature but has not received much attention in pediatrics. We sought to use a telemedicine platform for the characterization of PICS by creating a convenient and effective virtual follow-up clinic. Prospective single-center study in a pediatric intensive care unit (ICU) of patients aged 4-17 years who underwent any invasive procedures while admitted to the ICU. Parents completed the Weiss Functional Impairment Rating Scale (WFIRS) based on baseline behaviors before ICU admission, with the scale readministered at 1 week, 1 month, and 3 months postdischarge via secure telehealth platform. Patients with a WFIRS baseline raw score of 10 or an interval increase of 2 were referred to psychiatry for evaluation and treatment. Fifty patients were enrolled. Risk factors for PICS included number of procedural interventions, length of pediatric ICU stay, number of specialty consults, sex, race, and duration of sedation/airway instrumentation. In univariate analysis, age appeared to be the only statistically significant factor associated with the development of PICS. Variables associated with a higher change in WFIRS score showed a statistically significant correlation with the number of procedures completed, the number of specialists involved, and the need for a psychiatric referral. Only 34% of total telemedicine follow-ups were completed. There is an association between age and the development of PICS and between change in WFIRS score and number of procedures, specialist involved, and psychiatric referral. The use of telemedicine did not result in an improved follow-up rate when compared to outpatient clinic studies.
