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Change in Functional Status During Hospital Admission and Long-Term Health-Related Quality of Life Among Pediatric
Jennifer K Workman1, Ron W Reeder1, Russell K Banks1
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Insights
Worsening functional status during pediatric septic shock hospitalization is linked to reduced long-term health-related quality of life (HRQL). This change can help identify children at risk for lasting HRQL deficits.
Area of Science:
- Pediatric critical care medicine
- Septic shock outcomes research
- Health-related quality of life assessment
Background:
- Pediatric septic shock survivors may experience long-term health-related quality of life (HRQL) deficits.
- Understanding factors associated with reduced HRQL is crucial for improving post-discharge care.
Purpose of the Study:
- To determine if changes in functional status from before hospitalization to discharge correlate with long-term HRQL in children who survived septic shock.
- To identify potential indicators for long-term HRQL reduction in pediatric septic shock survivors.
Main Methods:
- Secondary analysis of the prospective Life After Pediatric Sepsis Evaluation (LAPSE) cohort study.
- Included children aged 1 month to 18 years admitted to 12 U.S. academic PICUs who survived to discharge.
- Assessed functional status using the Functional Status Scale (FSS) pre-hospitalization and at discharge; HRQL measured using FSII-R or PedsQL at 3 and 12 months post-PICU admission.
Main Results:
- Among children with developmental delay (n=88), worsened FSS correlated with lower FSII-R at 3 months (p=0.003).
- Among typically developing children (n=136), worsened FSS correlated with lower PedsQL at 3 and 12 months.
- Neurologic insults further decreased PedsQL in typically developing children, but worsened FSS remained a significant predictor of poor HRQL.
Conclusions:
- Changes in functional status during septic shock hospitalization are associated with diminished long-term HRQL in pediatric survivors.
- Functional Status Scale (FSS) changes may serve as a valuable tool to identify children at risk for persistent HRQL impairments after septic shock.
Objectives:
To investigate whether change in functional status from pre-hospitalization baseline to hospital discharge is associated with long-term health-related quality of life (HRQL) among children surviving septic shock.
Design:
Secondary analysis of Life After Pediatric Sepsis Evaluation (LAPSE), a prospective cohort study of children with community-acquired septic shock, enrolled from January 2014 to June 2017.
Setting:
Twelve U.S. academic PICUs.
Patients:
Children, 1 month to 18 years, who survived to hospital discharge and had follow-up data for HRQL at 3 and/or 12 months.
Interventions:
None.
Measurements And Main Results:
Functional Status Scale (FSS) was assessed around enrollment to ascertain baseline status (pre-hospitalization) and at 28 days or hospital discharge. Two measures of HRQL were utilized: children with significant development delay were measured with the Functional Status II-R (FSII-R); typically, developing children were measured with the Pediatric Quality of Life Inventory (PedsQL). Each group was analyzed separately with multivariable regression modeling to determine the association between change in FSS from baseline to day 28 and HRQL at 3 and 12 months from PICU admission. Of the original 389 LAPSE participants, 224 (58%) are included. Among children with developmental delay ( n = 88), worsened FSS was associated with lower FSII-R at 3 months from PICU admission (-2.02; 95% CI, -3.34 to -0.0.71; p = 0.003), but not 12 months. Among developmentally typical children ( n = 136), worsened FSS was associated with lower PedsQL at both 3 and 12 months. Developmentally typical children with a neurologic insult during the PICU stay had the largest decrement in PedsQL at 12 months (-14.04 mo; 95% CI, -22.15 to -5.94 mo; p < 0.001). However, worsened FSS remained associated with poor HRQL-PedsQL at 3 and 12 months, after controlling for neurologic events (both p < 0.001).
Conclusions:
Change in FSS during hospitalization for septic shock is associated with long-term reductions in HRQL and could serve as a useful tool for identifying children at risk for this sequela.
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