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Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care
Cydni N Williams1,2, Carl O Eriksson2, Aileen Kirby2
1Pediatric Critical Care and Neurotrauma Recovery Program and willicyd@ohsu.edu.
Insights
Pediatric neurocritical care (PNCC) patients face high death rates and new disabilities post-discharge. Outcomes vary significantly by diagnosis, highlighting the need for ongoing multidisciplinary care for survivors.
Area of Science:
- Neurology
- Critical Care Medicine
- Pediatrics
Background:
- Outcomes research in pediatric neurocritical care (PNCC) is limited.
- Understanding patient outcomes is crucial for improving care and resource allocation.
Purpose of the Study:
- To evaluate mortality and changes in Functional Status Scale (FSS) from baseline in pediatric neurocritical care (PNCC) patients.
- To identify variations in outcomes among different PNCC diagnoses.
Main Methods:
- An observational study of 325 children (0-18 years) admitted to the ICU with a primary neurologic diagnosis.
- Primary outcomes included death and change in FSS from preadmission baseline to discharge.
- New disability defined as FSS change ≥1; severe disability as FSS change ≥3.
Main Results:
- Thirty (9%) patients died. New disability (35%) and severe disability (13%) were common in survivors.
- Outcomes varied significantly by diagnosis, with infectious/inflammatory and stroke cohorts showing higher disability rates.
- Disability affected multiple domains, including sensory, motor, and communication; critical care interventions and seizures were associated with new disability.
Conclusions:
- Pediatric neurocritical care patients experience high rates of mortality and new disability at discharge.
- Significant variations in outcomes across diagnoses necessitate tailored, multidisciplinary care approaches.
- This study provides essential data for advancing future research in pediatric neurocritical care.
Objectives:
Pediatric neurocritical care (PNCC) outcomes research is scarce. We aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses.
Methods:
We conducted a 2-year observational study of children aged 0 to 18 years admitted to the ICU with a primary neurologic diagnosis (N = 325). Primary outcomes were death and change in FSS from preadmission baseline to discharge. New disability was defined as an FSS change of ≥1 from baseline, and severe disability was defined as an FSS change of ≥3. Categorical results are reported as relative risk (RR) with 95% confidence interval (CI).
Results:
Thirty (9%) patients died. New disability (n = 103; 35%) and severe disability (n = 37; 13%) were common in PNCC survivors. New disability (range 14%-54%) and severe disability (range 3%-33%) outcomes varied significantly among primary diagnoses (lowest in status epilepticus; highest in infectious and/or inflammatory and stroke cohorts). Disability occurred in all FSS domains: mental status (15%), sensory (52%), communication (38%), motor (48%), feeding (40%), and respiratory (12%). Most (64%) patients with severe disability had changes in ≥3 domains. Requiring critical care interventions (RR 2.1; 95% CI 1.5-3.1) and having seizures (RR 1.5; 95% CI 1.1-2.0) during hospitalization were associated with new disability.
Conclusions:
PNCC patients have high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability are affected, underscoring the ongoing multidisciplinary health care needs of survivors. Our study quantified hospital outcomes of PNCC patients that can be used to advance future research in this vulnerable population.
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