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Mobilization of Children with External Ventricular Drains: A Retrospective Cohort Study
Ben Reader1, Emily Stegeman2, Nanhua Zhang3,4
1Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH 43205, USA.
Insights
Early mobility programs for children with external ventricular drains (EVDs) are safe and effective. Physical therapy mobilization improved patient activity, reduced hospital stays, and led to better discharge outcomes.
Area of Science:
- Pediatric critical care
- Neurology
- Rehabilitation medicine
Background:
- Early mobility programs are increasingly implemented for critically ill children.
- Children with acute neurologic conditions requiring external ventricular drains (EVDs) are often excluded from early mobility due to safety concerns.
- Limited evidence exists on the safety and efficacy of early mobilization for pediatric patients with EVDs.
Purpose of the Study:
- To examine the implementation, safety, and outcomes of early mobilization for children with EVDs.
- To assess the feasibility of physical therapists leading mobilization for this patient population.
- To determine if early mobilization impacts functional status and hospital length of stay.
Main Methods:
- A single-site retrospective cohort study was conducted.
- Included patients aged 3-21 years with EVDs hospitalized between September 2016 and December 2020.
- Analyzed data from 168 patients who underwent 1601 early mobilization encounters led by physical therapists.
Main Results:
- No adverse events were reported during mobilization in patients with EVDs.
- Patients receiving more frequent physical therapy mobilization showed higher activity levels at discharge (p=0.014).
- Early mobilization was associated with a shorter length of stay (p=0.001) and more favorable discharge outcomes (p=0.03).
Conclusions:
- Early mobilization of children with EVDs can be safely implemented by physical therapists.
- Mobilizing children with EVDs leads to improved functional outcomes, reduced hospitalizations, and better discharge disposition.
- Physical therapist-led early mobilization is a safe and beneficial intervention for pediatric patients with EVDs.
Abstract:
The implementation of early mobility programs for children with critical illnesses has been growing. Children with acute neurologic conditions that result in the requirement of an external ventricular drain (EVD) may be excluded from attaining the benefits of early mobility programs due to the fear of adverse events. The purpose of this study was to examine the implementation, safety, and outcomes of children with EVDs mobilized by physical therapists. A single-site retrospective cohort study of children with EVDs mobilized by physical therapy (PT) was conducted. Patients aged 3-21 years who were hospitalized from September 2016 to December 2020 were included in this study. Results: Out of a total of 192 electronic health records with EVDs, 168 patients (87.5%) participated in 1601 early mobilization encounters led by physical therapists. No adverse events occurred due to mobilization. Patients mobilized more frequently by PT had a higher level of activity at discharge (p = 0.014), a shorter length of stay (p = 0.001), and a more favorable discharge (p = 0.03). The early mobilization of children with EVDs can be implemented safely without adverse events. Patients mobilized with an EVD are more functional at discharge, spend fewer days in the hospital, and have a more favorable discharge compared to those who do not receive PT.
