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Pediatric Chronic Critical Illness: Protocol for a Scoping Review
David Zorko1, James Dayre McNally2,3, Bram Rochwerg4,5,6
1Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Insights
This study reviews definitions of chronic critical illness (CCI) in children, aiming to establish a consensus case definition. It uses a novel hybrid approach combining crowdsourcing and machine learning for efficient data review.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Medical informatics
Background:
- Increased survival in pediatric intensive care units (PICUs) leads to more children with chronic complex medical conditions.
- A subset of these children face recurrent critical illness, high morbidity, and mortality, termed chronic critical illness (CCI).
- Pediatric CCI remains understudied with no universally accepted case definition.
Purpose of the Study:
- To conduct a scoping review of how pediatric chronic critical illness (CCI) is defined in existing literature.
- To analyze methodologies used for developing current definitions and identify patient characteristics and outcomes studied.
- To inform the development of a consensus case definition for pediatric CCI.
Main Methods:
- Systematic search of four electronic databases for studies on pediatric CCI and prolonged PICU admission.
- Hybrid crowdsourcing and machine learning (ML) methodology for citation screening.
- Independent, duplicate screening and data abstraction by two reviewers, focusing on definitions, demographics, clinical characteristics, and outcomes.
Main Results:
- Database searching, crowd reviewer recruitment, and ML algorithm development commenced in March 2021.
- Citation screening and data abstraction were completed by April 2021.
- Final data verification is ongoing, with analysis and results expected by fall 2021.
Conclusions:
- The scoping review will delineate existing definitions of pediatric CCI and associated patient characteristics.
- Findings will guide the creation of a consensus case definition for pediatric CCI and prioritize future research.
- The study will validate the use of crowdsourcing and ML for efficient large-scale scoping reviews.
Background:
Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). To date, pediatric CCI has been understudied and lacks an accepted consensus case definition.
Objective:
This study aims to describe the protocol and methodology used to perform a scoping review that will describe how pediatric CCI has been defined in the literature, including the concept of prolonged PICU admission and the methodologies used to develop any existing definitions. It also aims to describe patient characteristics and outcomes evaluated in the included studies.
Methods:
We will search four electronic databases for studies that evaluated children admitted to any PICU identified with CCI. We will also search for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. Furthermore, we will develop a hybrid crowdsourcing and machine learning (ML) methodology to complete citation screening. Screening and data abstraction will be performed by 2 reviewers independently and in duplicate. Data abstraction will include the details of population definitions, demographic and clinical characteristics of children with CCI, and evaluated outcomes.
Results:
The database search, crowd reviewer recruitment, and ML algorithm development began in March 2021. Citation screening and data abstraction were completed in April 2021. Final data verification is ongoing, with analysis and results anticipated to be completed by fall 2021.
Conclusions:
This scoping review will describe the existing or suggested definitions of pediatric CCI and important demographic and clinical characteristics of patients to whom these definitions have been applied. This review's results will help inform the development of a consensus case definition for pediatric CCI and set a priority agenda for future research. We will use and demonstrate the validity of crowdsourcing and ML methodologies for improving the efficiency of large scoping reviews.
International Registered Report Identifier (Irrid):
DERR1-10.2196/30582.
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