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Long-term survival and state of health after paediatric intensive care
R J Gemke1, G J Bonsel, A J van Vught
1Department of Paediatric Intensive Care, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
One year after intensive care unit (ICU) discharge, survival was favorable for children. Most survivors showed improved or stable health status, indicating positive long-term outcomes post-pediatric critical care.
Area of Science:
- Pediatric critical care medicine
- Long-term health outcomes
- Quality of life assessment
Background:
- Children admitted to intensive care units (ICUs) face risks of mortality and long-term health impairment.
- Assessing health status post-ICU discharge is crucial for understanding recovery trajectories.
- Pre-existing health conditions can influence outcomes in critically ill children.
Purpose of the Study:
- To evaluate one-year survival and health status in children after intensive care unit admission.
- To determine the prevalence and impact of chronic health impairment on recovery.
- To analyze changes in specific health domains (sensation, mobility, emotion, cognition, self-care, pain) post-ICU.
Main Methods:
- Prospective study assessing 468 children admitted to an ICU.
- One-year follow-up for survival and health status using a validated six-domain classification (excluding infants).
- Analysis of health status compared to pre-admission state in survivors.
Main Results:
- One-year mortality was 10.5%.
- Among 254 eligible patients, 72.6% of survivors had improved or unchanged health status one year post-discharge.
- Significant proportions of survivors showed improvement or stability in specific domains, particularly mobility and pain (89.4%).
Conclusions:
- One-year survival following pediatric intensive care is generally favorable.
- Despite pre-existing health impairments in many, a majority of survivors experience stable or improved health status.
- Recovery in specific health domains is common, suggesting effective rehabilitation and care post-ICU.
Abstract:
Survival and state of health were assessed one year after discharge in 468 children admitted to an intensive care unit (ICU). ICU mortality was 7.5%, cumulative hospital mortality 8.3%, and one year mortality 10.5%. An established six domain health status classification was used, comprising sensation, mobility, emotion, cognition, self care, and pain to determine the presence, type, and severity of chronic health impairment. This classification has not been validated for infants, who were therefore excluded. After one year, of the 254 patients eligible for analysis, 80 (31.5%) had no overall health impairment (no affected domains) preceding admission; of these, 11 had died in ICU and 69 were long-term survivors, among whom 45 recovered to perfect health. There was overall health impairment (> or = 1 affected domain) preceding admission in 174 of 254 patients (68.5%). However, after one year, overall state of health was improved or equal to the preadmission state in 164 of 226 survivors (72.6%). In domain-specific health, the proportion improving or remaining unchanged varied from 77.9% (emotional functions) to 89.4% (mobility and pain). Consequently, despite the large number with health impairment before admission, cumulative one year survival was favourable and health status in three quarters of the population was preserved.