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Scoping Review: Neurocognitive Outcome Assessments After Critical Illness in Children
Katherine V Biagas1, Julia A Heneghan2, Samer Abu-Sultaneh3
112300The Renaissance School of Medicine at Stony Brook University and the Stony Brook Children's Hospital, Stony Brook, USA.
Insights
This review maps neurocognitive assessment in pediatric intensive care unit survivors, finding varied methods but a growing interest in Post-Intensive Care Syndrome-pediatrics (PICS-p) outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Neuroscience
- Developmental Psychology
Background:
- Pediatric survivors of intensive care often experience neurocognitive deficits, termed Post-Intensive Care Syndrome-pediatrics (PICS-p).
- Standardized assessment of these outcomes is crucial for understanding long-term impacts and developing targeted interventions.
- Existing literature on neurocognitive assessment in this population is fragmented, necessitating a comprehensive overview.
Purpose of the Study:
- To systematically map the existing literature on the assessment of neurocognitive outcomes in pediatric intensive care unit (PICU) survivors.
- To identify gaps in current research regarding neurocognitive assessment methodologies and populations.
- To inform the development of a standardized Core Outcome Measures Set for the neurocognitive domain of PICS-p.
Main Methods:
- A scoping review of English-language manuscripts published between 1970 and 2017 was conducted.
- A medical librarian identified relevant studies from databases and registries focusing on PICS-p functional outcomes.
- Detailed data extraction focused on study characteristics, neurocognitive instruments used, and patient populations.
Main Results:
- 183 manuscripts evaluated neurocognitive function using 114 distinct instruments, with 83% published after 2000.
- Wechsler Scales, clinical neurologic evaluations, Pediatric Cerebral Performance Category, and Bayley Scales were commonly used.
- Most studies focused on adolescents and specific populations like congenital heart disease and TBI survivors, with limited assessment of baseline function or longitudinal follow-up.
Conclusions:
- A significant body of literature addresses the neurocognitive domain of PICS-p, primarily using quantitative methods and focusing on at-risk populations.
- Despite variability in assessment tools, a few instruments are frequently employed for intelligence, cerebral function, and developmental/adaptive behavior.
- The field shows burgeoning interest but lacks methodological consensus, highlighting the need for standardized approaches to neurocognitive outcome assessment in PICU survivors.
Objectives:
To map the literature regarding assessment of neurocognitive outcomes in PICU survivors. Secondary objectives were to identify literature gaps and to provide data for development of a Core Outcome Measures Set in the domain.
Methods:
Planned, a priori analysis was performed of data from an over-all scoping review of Post-Intensive Care Syndrome-pediatrics (PICS-p) functional outcomes. English-language databases and registries from 1970 to 2017 were searched by a medical librarian to identify manuscripts reporting on Post Intensive Care Syndrome-pediatrics (PICS-p). Further, detailed data extraction for neurocognitive outcomes was performed focusing on study characteristics, instruments used, and populations.
Results:
114 instruments evaluated neurocognitive function in 183 manuscripts. 83% of manuscripts were published after 2000. Median of 3 (IQR 2-5) neurocognitive instruments per manuscript were reported. Wechsler Scales (45%), clinical neurologic evaluations (21%), Pediatric Cerebral Performance Category (20%), Bayley Scales of Infant Development (16%), and Vineland Adaptive Behavior Scales (11%) were the most commonly used instruments. Median sample size was 65 (IQR 32-129) subjects. Most (63%) assessments were conducted in-person and parents/guardians (40%) provided the information. Patients with congenital heart disease and traumatic brain injury were most commonly evaluated (31% and 24% of manuscripts, respectively). Adolescents were the most commonly studied age group (34%). Baseline function was infrequently assessed (11% of manuscripts); most studies assessed patients at only one time point after PICU discharge. Within studies, neurocognitive assessments were often combined with others - especially social (18%) and physical (8%).
Conclusions:
183 manuscripts studied the neurocognitive domain of PICS-p. Studies were quantitative and tended to focus on populations with anticipated cognitive impairment. Considerable variability exists among the chosen 114 instruments used; however, 4 instruments were frequently chosen with focus on intelligence, cerebral functioning, and developmental and adaptive behavior. The literature is marked by lack of agreement on methodologies but reflects the burgeoning interest in studying PICS-p neurocognitive outcomes.
