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Assessing Functional Outcomes in the Pediatric Neurocritical Care Population After Discharge: A Pilot Study
Amelia M Sperber1, Nathan Chang2, May Casazza2,3
1Center for Professional Excellence & Inquiry, Lucile Packard Children's Hospital Stanford, Palo Alto, California.
Insights
Pediatric neurocritical care patients often experience functional decline. Mechanical ventilation is a key predictor, highlighting the need for targeted follow-up to improve outcomes.
Area of Science:
- Pediatric critical care medicine
- Neurocritical care
- Child neurology
Background:
- Pediatric neurocritical care (PNCC) patients face significant morbidity.
- Comprehensive follow-up care is not consistently provided to these children.
- Identifying predictors of functional decline is crucial for resource allocation.
Purpose of the Study:
- To identify predictors of functional decline in pediatric neurocritical care patients.
- To guide future resource allocation for follow-up programs.
- To improve health-related quality of life for children post-PICU discharge.
Main Methods:
- Prospective observational study in a quaternary children's hospital PICU (July-December 2023).
- Enrolled 30 caregivers of patients (aged 3-17 years) with PNCC diagnoses.
- Assessed functional status using the Functional Status Scale (FSS) at baseline and 2-month follow-up.
Main Results:
- 17 (58.6%) patients experienced functional decline.
- Mechanical ventilation was a significant predictor of functional decline (OR, 6.50; P=.025).
- Only 41.4% returned to school; 55.2% faced new family hardships.
Conclusions:
- This study confirms high morbidity in pediatric neurocritical illness survivors.
- Patients on mechanical ventilation are at higher risk for functional decline.
- Targeted follow-up for high-risk patients can optimize resource allocation and enhance quality of life.
Objectives:
Pediatric neurocritical care (PNCC) patients experience high rates of morbidity, but comprehensive follow-up is not universal. We sought to identify predictors of functional decline in these children to guide future resource allocation.
Patients And Methods:
We conducted a prospective observational study in a quaternary children's hospital pediatric intensive care unit (PICU) from July 2023 to December 2023. Patients (aged 3-17 years) were admitted with a PNCC diagnosis, and their caregivers were enrolled. Outcomes were assessed through surveys using the Functional Status Scale (FSS) at time of consent (baseline) and the 2-month follow-up after PICU discharge. Follow-up surveys explored social, educational, and cognitive difficulties encountered after discharge. Functional decline was defined as any increase in FSS between baseline and follow-up, and severe morbidity was defined as an overall increase of 3 or more or an increase of 2 or more in one domain. Demographic and in-hospital variables were extracted from a clinical database to analyze with outcomes.
Results:
A total 30 of 31 families consented, and 29 completed follow-up surveys. Out of those, 17 (58.6%) patients had a functional decline, 8 (27.6%) had a new severe morbidity, only 12 (41.4%) had returned to school, and 16 (55.2%) had new family hardships. Mechanical ventilation was a significant predictor of functional decline (odds ratio, 6.50, 95% CI, 1.26-33.58; P = .025).
Conclusions:
This study supplements reports of high morbidity after pediatric neurocritical illness. Targeting patients most at risk for functional decline, such as those receiving mechanical ventilation, can support efficient resource allocation for follow-up programs promoting health-related quality of life. Larger studies are needed to validate and expand on these findings.
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