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Health-Related Quality of Life After Community-Acquired Septic Shock in Children With Preexisting Severe
Kathleen L Meert1, Ron W Reeder2, Aline B Maddux3
1Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
Insights
Children with severe developmental disabilities experiencing septic shock have a lower quality of life post-illness. Single-parent families are at higher risk, highlighting the need for targeted support and awareness.
Area of Science:
- Pediatric critical care medicine
- Developmental disabilities research
- Quality of life studies
Background:
- Community-acquired septic shock poses significant risks to children.
- Children with pre-existing severe developmental disabilities face unique challenges during critical illness.
- Assessing health-related quality of life (HRQoL) is crucial for this vulnerable population.
Purpose of the Study:
- To evaluate HRQoL in children with severe developmental disabilities during the first year after septic shock.
- To identify factors influencing HRQoL changes in these children.
Main Methods:
- Secondary analysis of the Life after Pediatric Sepsis Evaluation (LAPSE) investigation.
- Utilized the Stein-Jessop Functional Status II-R Short Form to measure HRQoL.
- Data collected at baseline, day 7, and months 1, 3, 6, and 12 post-PICU admission.
Main Results:
- 137 children with severe developmental disabilities were included.
- 11.6% of children with severe disability died within 12 months.
- Survivors' HRQoL scores declined significantly from baseline and remained low throughout the year.
- Caregiver being a single parent was associated with lower month 3 HRQoL scores.
Conclusions:
- Children with severe developmental disabilities experience a sustained decline in HRQoL after septic shock.
- Children in single-parent families with severe disability and septic shock are at increased risk.
- Clinical vigilance is essential to recognize and address the diminished HRQoL in this population.
Objectives:
To serially evaluate health-related quality of life during the first year after community-acquired septic shock in children with preexisting severe developmental disabilities and explore factors associated with health-related quality of life changes in these children.
Design:
Secondary analysis of the Life after Pediatric Sepsis Evaluation investigation.
Setting:
Twelve academic PICU in the United States.
Patients:
Children greater than or equal to 1 month and less than 18 years old identified by their family caregiver (e.g., parent/guardian) as having severe developmental disability prior to septic shock.
Interventions:
Family caregivers completed the Stein-Jessop Functional Status II-R Short Form as a measure of their child's health-related quality of life at baseline (reflecting preadmission status), day 7, and months 1, 3, 6, and 12 following PICU admission. Stein-Jessop Functional Status II-R Short Form scores were linearly transformed to a 0-100 scale, with higher scores indicating better health-related quality of life.
Measurements And Main Results:
Of 392 Life after Pediatric Sepsis Evaluation participants, 137 were identified by their caregiver as having a severe developmental disability. Sixteen children (11.6%) with severe disability died during the 12 months following septic shock. Among 121 survivors, Stein-Jessop Functional Status II-R Short Form scores declined from preadmission baseline to day 7 (70.7 ± 16.1 vs 55.6 ± 19.2; p < 0.001). Stein-Jessop Functional Status II-R Short Form scores remained below baseline through month 12 (59.1 ± 21.0, p < 0.001 vs baseline). After adjusting for baseline Stein-Jessop Functional Status II-R Short Form, the caregiver being a single parent/guardian was associated with lower month 3 Stein-Jessop Functional Status II-R Short Form scores (p = 0.041). No other baseline child or caregiver characteristic, or critical illness-related factors were significantly associated with month 3 Stein-Jessop Functional Status II-R Short Form scores.
Conclusions:
Health-related quality of life among children with severe developmental disability remains, on average, below baseline during the first year following community-acquired septic shock. Children with severe disability and septic shock that are in single parent families are at increased risk. Clinical awareness of the potential for decline in health-related quality of life among disabled children is essential to prevent this adverse outcome from being missed.
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