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Patient follow-up after discharge from the paediatric intensive care unit: A scoping review
Delphine Micaëlli1,2, Jérôme Naudin1, Stéphane Dauger1,3,4
1Médecine intensive et réanimation pédiatriques, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France.
Insights
Paediatric intensive care unit (PICU) survivors often face long-term challenges, yet follow-up care strategies are inconsistent. This review highlights the urgent need for standardized post-PICU discharge protocols to improve patient outcomes.
Area of Science:
- Pediatric Intensive Care
- Clinical Follow-up Strategies
- Post-Intensive Care Syndrome
Background:
- Increasing survival rates in pediatric intensive care units (PICUs) lead to more children experiencing long-term effects.
- Existing research identifies various impacts of PICU admission on children and families, but lacks expert follow-up recommendations.
- Paediatric post-intensive care syndrome (PICS-P) is a recognized concern for survivors.
Purpose of the Study:
- To systematically review and identify clinical follow-up strategies implemented after pediatric intensive care unit discharge.
- To analyze the period between 2001 and 2021 for trends in post-PICU follow-up care.
- To summarize current practices regarding the execution, personnel involved, and assessment objectives in post-PICU follow-up.
Main Methods:
- A comprehensive scoping review was conducted from January to April 2021.
- Searches were performed across PubMed, EMBASE, and CINAHL databases.
- Keywords included 'PICU', 'post-PICU discharge', and 'follow-up' for articles published between 2001 and 2021, adhering to PRISMA-ScR guidelines.
Main Results:
- Analysis of 68 articles from an initial 652 identified studies.
- Most follow-up care was research-based (88%), with limited multidisciplinary PICU team involvement (6%).
- Common follow-up schedules involved assessments at discharge, 3, 6, and 12 months, with 20% extending beyond one year. Quality of life and neurological outcomes were primary focuses, while parental emotional impact was assessed in only 7% of studies.
Conclusions:
- Significant heterogeneity exists in post-PICU discharge follow-up regarding timing, healthcare professionals, and assessment methods.
- There is a critical need for standardization and coordination of follow-up care due to the rising number of PICU survivors.
- The development of clinical guidelines for post-PICU follow-up is essential to address PICS-P and ensure comprehensive patient care.
Background:
Most children admitted to a paediatric intensive care unit (PICU) now survive because of improvements in care. Many studies have identified the psychological, functional, cognitive and social impact of PICU admission on a child and their family. However, expert recommendations on follow-up are lacking.
Aim:
To identify the strategies of clinical follow-up after PICU discharge performed from 2001 to 2021.
Study Design:
This scoping review was undertaken between January and April 2021 using three databases: PubMed, EMBASE and CINAHL. The search strategy consisted of a combination of keywords, including PICU, post-PICU discharge and follow-up in articles published between 2001 and 2021. The results are reported according to PRISMA-ScR guidelines.
Results:
Six-hundred and fifty-two articles were identified and 68 were analysed. Median age was 4.5 years and the two main reasons for PICU admission were cardiorespiratory failure and sepsis. Median length of PICU stay was 8 days. Most follow-up was carried out by research units (88%), while 6% of studies reported follow-up by a multidisciplinary PICU team. The most common follow-up schedule included an assessment at PICU discharge, and then at 3, 6 and 12 months. Follow-up for >1 year was reported in 20% of studies. One third of studies focused on follow-up quality of life and neurological outcomes. Parental emotional impact was assessed in 7% of studies.
Conclusion:
Follow-up after PICU discharge was highly heterogeneous regarding timing, health care professionals involved and assessment methods. There is an urgent need for standardization and coordination of PICU follow-up because of the increasing number of patients impacted by a PICU stay.
Relevance To Clinical Practice:
Although most patients admitted to a paediatric intensive care unit (PICU) now survive; they may develop paediatric post-intensive care syndrome (PICS-P). To our knowledge, there are currently no clinical guidelines regarding follow-up after PICU discharge. This review summarizes current approaches to follow-up after PICU discharge, including how it is carried out, who is involved and what the main aims of assessment are.
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