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Published on: January 16, 2019
Outcomes following admission to paediatric intensive care: A systematic review
Claire Procter1, Brenda Morrow2, Genee Pienaar3
1Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa.
Insights
Children admitted to paediatric intensive care units face increased long-term mortality and morbidity risks. Outcomes are worse in lower-income regions, highlighting the need for further research into modifiable factors.
Area of Science:
- Pediatric Intensive Care
- Long-term Health Outcomes
- Systematic Review
Background:
- Children admitted to paediatric intensive care units (PICUs) may experience significant long-term health consequences.
- Understanding these outcomes is crucial for improving post-PICU care and patient trajectories.
Purpose of the Study:
- To systematically review and describe the long-term health outcomes for children following admission to a paediatric intensive care unit.
- To identify trends in mortality and morbidity in this vulnerable population.
Main Methods:
- A systematic literature review was conducted, including studies on children under 18 admitted to PICUs.
- Studies on neonates or specific interventions/diagnoses were excluded.
- Outcomes assessed included mortality, neurodevelopment, physical, behavioral, psychosocial function, and quality of life.
Main Results:
- 111 studies were included, predominantly from high-income countries, focusing on short-term outcomes.
- In-hospital mortality varied widely (1.3-50%).
- Children face an increased risk of death for up to 10 years post-PICU, alongside greater physical and psychosocial morbidity and poorer quality of life, especially in lower-income regions.
Conclusions:
- Evidence on long-term pediatric intensive care outcomes is limited, with significant disparities based on resource availability.
- Morbidity burden is higher in less-resourced regions.
- Further research is recommended to identify risk and modifiable factors for improved outcomes.
Aim:
To describe the long-term health outcomes of children admitted to a paediatric intensive care unit.
Methods:
A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short-, medium- and long-term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life.
Results:
One hundred and eleven studies were included, most were conducted in high-income countries and focussed on short-term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high-income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life.
Conclusions:
There is limited high-level evidence for the long-term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.
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