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Educational Outcomes of Childhood Survivors of Critical Illness-A Population-Based Linkage Study
Wojtek Tomaszewski1, Christine Ablaza1, Lahn Straney2
1Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia.
Insights
Children surviving pediatric intensive care (PICU) show lower primary school achievement. Over 14% of survivors did not meet national standards, highlighting the need for targeted follow-up for at-risk children.
Area of Science:
- Pediatric critical care medicine
- Developmental pediatrics
- Educational psychology
Background:
- Postintensive care syndrome (PICS) affects many adult survivors.
- Limited data exists on long-term educational outcomes for pediatric intensive care unit (PICU) survivors.
- This study addresses the gap by examining primary school performance in childhood PICU survivors.
Purpose of the Study:
- To assess primary school educational outcomes in a statewide cohort of children who survived pediatric intensive care.
- To identify factors associated with lower educational achievement in these children.
Main Methods:
- A population-based study involving children under 5 years admitted to PICU in Queensland, Australia.
- Utilized the National Assessment Program-Literacy and Numeracy database for Year 3 primary school results.
- Compared PICU survivors with matched controls using multivariable logistic regression.
Main Results:
- 14.03% of 5,017 PICU survivors did not meet the National Minimum Standard (NMS), compared to 8.96% of controls (p < 0.001).
- Lower scores were observed across all assessment domains for PICU survivors (p < 0.001).
- Factors independently associated with not meeting NMS included socioeconomic status, lower weight, higher Pediatric Index of Mortality-2 score, presence of a syndrome, prematurity, chronic neurologic/respiratory conditions, and continuous renal replacement therapy.
Conclusions:
- A significant proportion of childhood PICU survivors do not meet national minimum standards in primary school assessments.
- Risk stratification using socioeconomic status, underlying conditions, and disease severity can identify children needing tailored support.
- Early identification and intervention are crucial for improving long-term educational trajectories of PICU survivors.
Objectives:
Major postintensive care sequelae affect up to one in three adult survivors of critical illness. Large cohorts on educational outcomes after pediatric intensive care are lacking. We assessed primary school educational outcomes in a statewide cohort of children who survived PICU during childhood.
Design:
Multicenter population-based study on children less than 5 years admitted to PICU. Using the National Assessment Program-Literacy and Numeracy database, the primary outcome was educational achievement below the National Minimum Standard (NMS) in year 3 of primary school. Cases were compared with controls matched for calendar year, grade, birth cohort, sex, socioeconomic status, Aboriginal and Torres Strait Islander status, and school. Multivariable logistic regression models to predict educational outcomes were derived.
Setting:
Tertiary PICUs and mixed ICUs in Queensland, Australia.
Patients:
Children less than 5 years admitted to PICU between 1998 and 2016.
Interventions:
Not applicable.
Measurements And Main Results:
Year 3 primary school data were available for 5,017 PICU survivors (median age, 8.0 mo at first PICU admission; interquartile range, 1.9-25.2). PICU survivors scored significantly lower than controls across each domain (p < 0.001); 14.03% of PICU survivors did not meet the NMS compared with 8.96% of matched controls (p < 0.001). In multivariate analyses, socioeconomic status (odds ratio, 2.14; 95% CI, 1.67-2.74), weight (0.94; 0.90-0.97), logit of Pediatric Index of Mortality-2 score (1.11; 1.03-1.19), presence of a syndrome (11.58; 8.87-15.11), prematurity (1.54; 1.09-2.19), chronic neurologic conditions (4.38; 3.27-5.87), chronic respiratory conditions (1.65; 1.24-2.19), and continuous renal replacement therapy (4.20; 1.40-12.55) were independently associated with a higher risk of not meeting the NMS.
Conclusions:
In this population-based study of childhood PICU survivors, 14.03% did not meet NMSs in the standardized primary school assessment. Socioeconomic status, underlying diseases, and severity on presentation allow risk-stratification to identify children most likely to benefit from individual follow-up and support.
