Functional Morbidity Within 12 Months Following PICU Discharge Using Validated Screening Tools

The objective of this study was to characterize the prevalence, trajectory, and risk factors of acquired dysfunction following critical illness compared with pre-illness status using age-appropriate, validated screening tools.

This was a single-center prospective study of a convenience sample of children aged 1 month to 17 years who were admitted to the pediatric intensive care unit (PICU) in a tertiary academic children's hospital between May 2019 and October 2022 for more than 24 hours with expected survival. Pre-illness baseline developmental status was measured on study enrollment using validated, age-appropriate tools that assess multiple domains. Assessments were repeated 1, 6, and 12 months following PICU discharge.

The median (IQR) age of 286 patients was 3.4 (0.8, 10.8) years, the median (IQR) PICU length of stay (LOS) was 2.9 (1.8, 5.8) days, and 24% received invasive mechanical ventilation (IMV). Acquired dysfunction, defined as scores at least 1 SD below the child's baseline in majority of domains, was observed in 13% of children at 1 month following discharge. In univariate analysis, acquired dysfunction was associated with female sex (18% of female vs 9% of male individuals; P = .023), IMV (23% vs 9%, respectively; P = .002), and longer median (IQR) PICU LOS (5.2 [2.0, 10.2] vs 2.8 [1.7, 5.0], respectively; P = .016). IMV was associated with acquired dysfunction in multivariable modeling (odds ratio, 2.72, 95% CI: 1.18-6.30; P = .019). At their last assessments, 15% of patients had returned to baseline in all domains; 35% of patients demonstrated persistence of acquired dysfunction in most/all domains.

Approximately 1 in 8 children have acquired dysfunction following PICU discharge, with significantly greater risk in those patients who received IMV; most did not fully return to baseline within 6 to 12 months.