Postdischarge Outcome Domains in Pediatric Critical Care and the Instruments Used to Evaluate Them: A Scoping Review
Aline B Maddux1, Neethi Pinto2, Ericka L Fink3
1Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Insights
Assessing pediatric critical illness recovery requires evaluating diverse outcomes. This review identified numerous domains and instruments, highlighting the need for standardized assessment to improve patient and family care.
Area of Science:
- Pediatric critical care research
- Health outcomes assessment
- Scoping literature review
Background:
- Evaluating outcomes post-pediatric critical illness is crucial for enhancing patient and family recovery.
- Current assessments lack standardization, hindering comprehensive understanding.
Purpose of the Study:
- To identify outcome domains and instruments used in pediatric critical care research.
- To inform the development of standardized assessment tools for post-discharge outcomes.
Main Methods:
- Conducted a comprehensive scoping review of multiple databases (PubMed, EMBASE, PsycINFO, CINAHL, Cochrane).
- Included studies published between 1970 and 2017, focusing on pediatric critical care survivors and their families.
- Excluded studies with solely mortality, psychometric, or procedural outcomes, or populations outside the 1-month to 18-year age range.
Main Results:
- Analyzed 407 articles, with 87% published after 2000, predominantly observational studies.
- Traumatic brain injury, general critical illness, and congenital heart disease were common populations studied.
- Social, cognitive, and overall health domains were most frequently assessed, utilizing a median of 2 instruments and 2 domains per study.
- A wide array of 366 unique instruments were identified, with significant heterogeneity in their application.
Conclusions:
- Heterogeneity in methods, populations, domains, and instruments limits a comprehensive understanding of pediatric critical illness outcomes.
- Developing standardized assessment approaches is essential for improving the understanding of post-discharge recovery.
- Standardized assessments can facilitate the development of targeted interventions for pediatric critical care survivors and their families.
Objectives:
Assessing outcomes after pediatric critical illness is imperative to evaluate practice and improve recovery of patients and their families. We conducted a scoping review of the literature to identify domains and instruments previously used to evaluate these outcomes.
Design:
Scoping review.
Setting:
We queried PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials Registry for studies evaluating pediatric critical care survivors or their families published between 1970 and 2017. We identified articles using key words related to pediatric critical illness and outcome domains. We excluded articles if the majority of patients were greater than 18 years old or less than 1 month old, mortality was the sole outcome, or only instrument psychometrics or procedural outcomes were reported. We used dual review for article selection and data extraction and categorized outcomes by domain (overall health, emotional, physical, cognitive, health-related quality of life, social, family).
Subjects:
Manuscripts evaluating outcomes after pediatric critical illness.
Interventions:
None.
Measurements And Main Results:
Of 60,349 citations, 407 articles met inclusion criteria; 87% were published after 2000. Study designs included observational (85%), interventional (7%), qualitative (5%), and mixed methods (3%). Populations most frequently evaluated were traumatic brain injury (n = 96), general pediatric critical illness (n = 87), and congenital heart disease (n = 72). Family members were evaluated in 74 studies (18%). Studies used a median of 2 instruments (interquartile range 1-4 instruments) and evaluated a median of 2 domains (interquartile range 2-3 domains). Social (n = 223), cognitive (n = 183), and overall health (n = 161) domains were most frequently studied. Across studies, 366 unique instruments were used, most frequently the Wechsler and Glasgow Outcome Scales. Individual domains were evaluated using a median of 77 instruments (interquartile range 39-87 instruments).
Conclusions:
A comprehensive, generalizable understanding of outcomes after pediatric critical illness is limited by heterogeneity in methodology, populations, domains, and instruments. Developing assessment standards may improve understanding of postdischarge outcomes and support development of interventions after pediatric critical illness.
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