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Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States
Sapna R Kudchadkar1,2,3, Archana Nelliot1, Ronke Awojoodu1
1Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Early physical rehabilitation is crucial for critically ill children, but its prevalence in pediatric intensive care units (PICUs) is low. Younger children, females, and those with better baseline function receive less rehabilitation, highlighting a gap in care.
Area of Science:
- Pediatric critical care medicine
- Rehabilitation medicine
- Pediatric intensive care unit (PICU) outcomes
Background:
- Decreasing mortality in PICUs leads to more survivors with long-term physical impairments.
- Early physical rehabilitation and mobilization are recognized as safe and feasible during critical illness.
- The prevalence and barriers to rehabilitation in PICUs remain largely unknown.
Purpose of the Study:
- To evaluate the prevalence of physical therapy- or occupational therapy-provided mobility in critically ill children.
- To identify factors associated with rehabilitation provision in PICUs.
- To explore barriers to early rehabilitation and mobilization for pediatric patients.
Main Methods:
- A national 2-day point prevalence study was conducted across 82 PICUs in 65 U.S. hospitals.
- Data collected included patient demographics, mobility status, rehabilitation consultation timing, and safety events.
- Statistical analysis identified associations between patient characteristics and mobility, as well as barriers to care.
Main Results:
- The point prevalence of mobility provided by physical or occupational therapy was 35% across 1,769 patient-days.
- Older age and male gender were associated with higher odds of mobility.
- Patients with higher baseline function and younger children were less likely to receive early rehabilitation consultation.
Conclusions:
- Rehabilitation is underutilized in U.S. PICUs, particularly for younger children, females, and those with better baseline function.
- Infrequent early rehabilitation consultation suggests a need for improved systematic approaches.
- Targeted interventions are necessary to ensure all critically ill children at risk of functional impairment receive timely rehabilitation.
Objectives:
With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers.
Design:
National 2-day point prevalence study.
Setting:
Eighty-two PICUs in 65 hospitals across the United States.
Patients:
All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day.
Interventions:
None.
Measurements And Main Results:
The primary outcome was prevalence of physical therapy- or occupational therapy-provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility-associated safety events, and barriers to mobility. The point prevalence of physical therapy- or occupational therapy-provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13-17 vs < 3 yr, 2.1; 95% CI, 1.5-3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61-0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1-0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1-0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1-6.6).
Conclusions:
Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.
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