Defining Pediatric Chronic Critical Illness: A Scoping Review

Area of Science:

• Pediatric critical care medicine
• Clinical definitions and research methodology

Background:

• Children with chronic critical illness (CCI) are a high-risk group with potential for prolonged organ dysfunction and recurrent critical care needs.
• However, a standardized definition for pediatric CCI is currently lacking, creating challenges in research and clinical practice.

Purpose of the Study:

• To conduct a scoping review of existing literature to identify and evaluate case definitions for pediatric chronic critical illness (CCI).
• To examine definitions of prolonged pediatric intensive care unit (PICU) admission and the methodologies used to derive these definitions.

Main Methods:

• A comprehensive search of four electronic databases (Ovid Medline, Embase, CINAHL, Web of Science) was performed up to March 2021.
• A hybrid approach combining crowdsourcing and machine learning was employed for efficient and accurate screening of over 6,000 citations.
• Studies providing specific case definitions for CCI or prolonged PICU admission were included for data extraction.

Main Results:

• Twelve of 67 included studies (18%) offered definitions for pediatric CCI, incorporating elements like PICU length of stay, medical complexity, chronic conditions, recurrent admissions, and technology dependence.
• Definitions for CCI were often referenced or opinion-based.
• The majority of studies (82%) defined prolonged PICU admission, typically as 14 or 28 days or longer, with definitions derived from investigator opinion or statistical methods.

Conclusions:

• Existing definitions for pediatric chronic critical illness are inconsistent, varying in their consideration of patient complexity and illness chronicity.
• The lack of a consensus definition impedes research in this critical area of pediatric critical care.
• Establishing a standardized definition for pediatric CCI is crucial for advancing research and improving patient outcomes.