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Published on: January 16, 2019
A Core Outcome Measurement Set for Pediatric Critical Care
Neethi P Pinto1,2, Aline B Maddux3, Leslie A Dervan4
1Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Insights
A core outcome measurement set (PICU COMS) was developed to evaluate pediatric intensive care unit (PICU) patient and family outcomes. This standardized set of measures will improve research comparability and long-term outcome assessment.
Area of Science:
- Pediatric Critical Care Medicine
- Outcomes Research
- Health Services Research
Background:
- Standardized outcome measurement is crucial for evaluating care quality and effectiveness in pediatric intensive care units (PICUs).
- Existing outcome measures may lack generalizability or fail to capture the full spectrum of patient and family experiences post-PICU.
- The development of a Pediatric Core Outcome Set (PICU COS) necessitates a corresponding Core Outcome Measurement Set (PICU COMS).
Purpose of the Study:
- To identify a Pediatric Core Outcome Measurement Set (PICU COMS).
- To establish a standardized set of measures for evaluating Pediatric Core Outcome Set (PICU COS) domains in PICU patients and their families.
- To facilitate comparability across research studies and inform interventions targeting long-term outcomes.
Main Methods:
- A modified Delphi consensus process was employed.
- Webinars were conducted with 35 international PICU physicians, nurses, surgeons, rehabilitation physicians, and scientists.
- Measures were evaluated for generalizability, feasibility, and relevance to PICU COS domains.
Main Results:
- 140 candidate measures were assessed, leading to the selection of 24 general measures.
- 10 measures achieved high consensus (≥80% agreement) for inclusion in the PICU COMS: 7 patient-oriented and 3 family-oriented.
- Six patient measures demonstrated broad applicability across diverse pediatric populations, diagnoses, and abilities, with validation and normative data.
Conclusions:
- The developed PICU COMS provides a standardized approach to measuring outcomes in PICU patients and families.
- This set of measures will enhance the comparability of future research studies on PICU survivorship.
- The PICU COMS will support interventional studies focused on improving long-term outcomes following pediatric critical illness.
Objectives:
To identify a PICU Core Outcome Measurement Set (PICU COMS), a set of measures that can be used to evaluate the PICU Core Outcome Set (PICU COS) domains in PICU patients and their families.
Design:
A modified Delphi consensus process.
Setting:
Four webinars attended by PICU physicians and nurses, pediatric surgeons, rehabilitation physicians, and scientists with expertise in PICU clinical care or research ( n = 35). Attendees were from eight countries and convened from the Pediatric Acute Lung Injury and Sepsis Investigators Pediatric Outcomes STudies after PICU Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network PICU COS Investigators.
Subjects:
Measures to assess outcome domains of the PICU COS are as follows: cognitive, emotional, overall (including health-related quality of life), physical, and family health. Measures evaluating social health were also considered.
Interventions:
None.
Measurements And Main Results:
Measures were classified as general or additional based on generalizability across PICU populations, feasibility, and relevance to specific COS domains. Measures with high consensus, defined as 80% agreement for inclusion, were selected for the PICU COMS. Among 140 candidate measures, 24 were delineated as general (broadly applicable) and, of these, 10 achieved consensus for inclusion in the COMS (7 patient-oriented and 3 family-oriented). Six of the seven patient measures were applicable to the broadest range of patients, diagnoses, and developmental abilities. All were validated in pediatric populations and have normative pediatric data. Twenty additional measures focusing on specific populations or in-depth evaluation of a COS subdomain also met consensus for inclusion as COMS additional measures.
Conclusions:
The PICU COMS delineates measures to evaluate domains in the PICU COS and facilitates comparability across future research studies to characterize PICU survivorship and enable interventional studies to target long-term outcomes after critical illness.
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