Latent Classes in Long-Term Functional Status in Children With Recurrent Critical Illness.

Area of Science:

• Pediatric critical care medicine
• Health outcomes research
• Longitudinal patient studies

Background:

• Understanding functional status trajectories is crucial for children with recurrent Pediatric Intensive Care Unit (PICU) admissions.
• Previous research has not fully characterized the diverse patterns of functional status changes in this vulnerable population.

Purpose of the Study:

• To identify and describe distinct trajectories of functional status in children experiencing multiple PICU admissions.
• To characterize the clinical and demographic factors associated with each identified functional status trajectory.

Main Methods:

• Retrospective analysis of data from 24 U.S. Pediatric Intensive Care Units (PICUs) between April 2017 and December 2022.
• Utilized the Functional Status Scale (FSS) to measure functional status at baseline and PICU discharge.
• Employed latent trajectory analysis to identify distinct longitudinal patterns (classes) of FSS scores in 6038 children with >1 PICU admission.

Main Results:

• Six latent functional status trajectory classes were identified: three stable (good, moderate, severe dysfunction), two worsening, and one improving.
• The stable good functional status class represented 46.6% of the cohort.
• Trajectory classes significantly differed based on age, race/ethnicity, diagnosis, procedural exposure, illness severity, and length of stay.

Conclusions:

• This study defines six distinct functional status outcome trajectories in children with recurrent PICU admissions.
• These trajectories exhibit unique clinical and demographic profiles, highlighting patient heterogeneity.
• Findings underscore the importance of individualized assessment and management for children with repeated critical care exposures.