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Long-term functional outcomes of children after critical illnesses: A cohort study
V C Dannenberg1, P M E Rovedder2, P R A Carvalho3
1Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
Insights
Children experiencing critical illness often have lasting functional decline, with 33% still affected one year later. Older age and better functional status at discharge are linked to improved long-term outcomes.
Area of Science:
- Pediatric critical care medicine
- Functional outcomes research
- Child health and development
Background:
- Pediatric critical illness can lead to significant short- and long-term functional impairments in children.
- Understanding the trajectory of functional recovery and associated factors is crucial for optimizing care.
Purpose of the Study:
- To evaluate the functional outcomes of children one year after pediatric critical illness.
- To identify factors influencing these long-term functional outcomes.
Main Methods:
- An ambispective cohort study was conducted in a pediatric intensive care unit (PICU).
- 128 children (1 month-17 years) who experienced critical illness were followed for one year.
- Demographic, clinical, and functional status data were collected and analyzed.
Main Results:
- A significant decline in functional status was observed over time (p<0.001).
- Functional decline persisted in 33% of children one year post-discharge.
- Older age ( >12 months) was protective, while impaired functional status at discharge increased the risk of poor long-term outcomes.
Conclusions:
- This study provides crucial baseline data on long-term functional outcomes after pediatric critical illness in Latin America.
- Functional decline at discharge is a strong predictor of persistent poor functional outcomes.
- Further multicenter studies are needed to deepen the understanding of pediatric critical illness impacts.
Objective:
To assess children's functional outcomes one year after critical illness and identify which factors influenced these functional outcomes.
Design:
Ambispective cohort study.
Setting:
Pediatric intensive care unit (PICU) in a tertiary academic center.
Participants:
Children (1 month-17-year-old) and their caregivers.
Interventions:
None.
Main Variables Of Interest:
Demographic, clinical, and functional status.
Results:
Of 242 patients screened, 128 completed the year follow-up. These children had significant changes in functional status over time (p<0.001). The functional decline occurred in 62% of children at discharge and, after one year, was persistent in 33%. Age>12 months was a protective factor against poor functional outcomes in two regression models (p<0.05). A moderately abnormal functional status and a severely/very severely abnormal functional status at discharge increased the risks of poor functional outcomes by 4.14 (95% CI 1.02-16.72; p=0.04), and 4.76 (CI 95% 1.19-19.0; p=0.02). A functional decline at discharge increased by 6.86 (95%CI: 2.16-21.79; p=0.001) the risks of children's long-term poor functional outcomes, regardless of the FSS scores.
Conclusion:
This is the first study evaluating long-term functional outcomes after pediatric critical illnesses in Latin America. Our findings show baseline data and raise relevant questions for future multicentre studies in this field in Latin America, contributing to a better understanding of the effects of critical illnesses on long-term functional outcomes in children.
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