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Functional Morbidity Within 12 Months Following PICU Discharge Using Validated Screening Tools
Debra J Rosenbaum1, Nori M Minich2,3, Rajashri Rasal2
1Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Pediatric intensive care unit (PICU) survivors face acquired dysfunction, with 13% affected one month post-discharge. Invasive mechanical ventilation (IMV) significantly increases this risk, and many children do not fully recover within a year.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental outcomes
- Pediatric intensive care unit (PICU) research
Background:
- Acquired dysfunction following critical illness can impact children's development.
- Understanding the prevalence, trajectory, and risk factors is crucial for early intervention.
- Validated screening tools are essential for accurate assessment.
Purpose of the Study:
- To characterize the prevalence and trajectory of acquired dysfunction in children after PICU discharge.
- To identify risk factors associated with acquired dysfunction compared to pre-illness status.
- To utilize age-appropriate, validated screening tools for comprehensive assessment.
Main Methods:
- Prospective, single-center study of children aged 1 month to 17 years admitted to the PICU.
- Pre-illness baseline developmental status assessed using validated tools.
- Follow-up assessments at 1, 6, and 12 months post-PICU discharge.
Main Results:
- 13% of children exhibited acquired dysfunction at 1 month post-discharge.
- Invasive mechanical ventilation (IMV) was a significant risk factor (OR 2.72).
- 35% of patients showed persistent acquired dysfunction at last assessment.
Conclusions:
- Approximately 1 in 8 children experience acquired dysfunction after PICU discharge.
- Children receiving IMV have a substantially higher risk of acquired dysfunction.
- Most children do not fully return to baseline function within 6-12 months post-PICU.
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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