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Functional Outcomes at 1 Year After PICU Discharge in Critically Ill Children With Severe Sepsis
Jhuma Sankar1, Sravanthi Moodu, Kiran Kumar
1All authors: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Severe sepsis in children often causes new functional disabilities upon PICU discharge, but most recover within a year. Key risk factors for poor outcomes include early organ dysfunction scores and CPR during ICU stay.
Area of Science:
- Pediatric critical care medicine
- Pediatric critical illness
- Sepsis research
Background:
- Severe sepsis poses a significant threat to critically ill children.
- Understanding functional outcomes and risk factors is crucial for improving care.
Purpose of the Study:
- To assess functional outcomes in children with severe sepsis using the Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) scales.
- To identify risk factors associated with worse outcomes in this patient population.
Main Methods:
- A prospective observational cohort study was conducted in a tertiary care Pediatric Intensive Care Unit (PICU).
- 121 children (2 months to 17 years) with severe sepsis were enrolled.
- Functional outcomes were assessed using POPC and PCPC at admission, PICU discharge, and 3 months and 1 year post-discharge. Risk factors for worse outcomes (death or new disability) were analyzed.
Main Results:
- At PICU discharge, over 50% of children experienced new overall functional disability (POPC) and 28% experienced new cognitive disability (PCPC).
- Most disabilities improved by 1-year follow-up, with only 5% having residual overall and 14% cognitive disability.
- PICU mortality was 26%, with 64% experiencing worse outcomes. Day 1 pediatric Sequential Organ Failure Assessment (pSOFA) score and cardiopulmonary resuscitation (CPR) during ICU stay were significant risk factors.
Conclusions:
- Children with severe sepsis frequently develop new functional disabilities post-PICU discharge, but significant recovery occurs within a year.
- Early identification of risk factors, such as elevated day 1 pSOFA scores and CPR, is vital for predicting and mitigating worse outcomes.
Objectives:
To evaluate the functional outcomes in critically ill children with severe sepsis using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale and to evaluate the risk factors for "worse outcomes."
Design:
Prospective observational cohort study.
Setting:
Tertiary care PICU from September 2017 to October 2019.
Patients:
One hundred twenty-one children with severe sepsis, 2 months to 17 years old, admitted to PICU.
Interventions:
None.
Measurements And Main Results:
Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores were recorded at admission, PICU discharge, at 3 months and 1 year after discharge. "New disability" was defined as Pediatric Overall Performance Category and Pediatric Cerebral Performance Category score change "from baseline score" by greater than or equal to 1 category. Risk factors for "worse outcomes" (defined as "death" or "new disability") were evaluated by univariate and multivariate analysis. At admission, 33% (n = 39) had mild to moderate "overall disability" (Pediatric Overall Performance Category) and 26% (n = 32) had mild to moderate "cognitive disability" (Pediatric Cerebral Performance Category). At PICU discharge (n = 89 children), 50.5% (n = 45) had "new disability" in overall function (Pediatric Overall Performance Category scores) and 28% (n = 25) had "new disability" in cognitive function (Pediatric Cerebral Performance Category scores). At 3 months follow-up (n = 85 children), "new disability" at PICU discharge improved in 65% (n = 28/43) and 50% (n = 12/24) of those with "overall disability" (Pediatric Overall Performance Category) and "cognitive disability" (Pediatric Cerebral Performance Category), respectively. At 1-year follow-up (n = 84 children), only 5% (n = 2/43) had residual "new disability" in overall function (Pediatric Overall Performance Category) and 14% (n = 3/21) had residual "new disability" in cognitive function. PICU mortality was 26% (n = 32). The proportion with "worse outcomes" was 64% (n = 77). Risk factors for worse outcomes on univariate analysis included higher Pediatric Index of Mortality-3 scores, day 1 pediatric Sequential Organ Failure Assessment score, receiving cardiopulmonary resuscitation during the ICU stay, and treatments received such as ventilation and Vasoactive-Inotrope Score. On multivariate analysis, only day 1 pediatric Sequential Organ Failure Assessment score and receiving cardiopulmonary resuscitation during the ICU stay were found to be statistically significant.
Conclusions:
Children with severe sepsis had significant "new onset" mild to moderate functional disability at PICU discharge, and most of these children recovered within 1 year after PICU discharge. Day 1 pediatric Sequential Organ Failure Assessment score and patient receiving cardiopulmonary resuscitation during the ICU stay were found to be the significant risk factors of "worse outcomes."
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