Jessica Nicoll, MD
Pediatric Critical Care Medicine Physician
Janeway Children's Health and Rehabilitation Centre
St. John's, NL, Canada
Disclosure information not submitted.
Christina Maratta, MD, FRCPC
Pediatric Critical Care Medicine Physician
Hospital for Sick Children
Toronto, Ontario, Canada
Disclosure information not submitted.
Anab Lehr, MD, FRCPC
Clinical Associate
CHEO, University of Ottawa, Quebec, Canada
Disclosure information not submitted.
Christopher Parshuram, MD
Pediatric Critical Care Medicine Physician, PhD
The Hospital for Sick Children, United States
Disclosure information not submitted.
Title: Pediatric function within one year of critical illness- systematic review and meta-analysis
Introduction: Overall, physical, cognitive, social-emotional and adaptive functioning after discharge are key outcomes for clinicians and caregivers after pediatric critical illness. Within instruments, function is commonly dichotomized as being favourable or unfavourable. Our objective was to describe the proportion of patients with favourable functional outcomes within one year after pediatric critical illness.
Methods: Using the Cochrane Prognosis Method Group Protocol for Prognosis Systematic Reviews and the Preferred Reporting Items for Systematic Review guidelines, a systematic search was performed across MEDLINE, Embase and Cochrane databases for cohorts and trials describing functioning in the first year after pediatric critical illness (PROSPERO CRD42020206335). Studies included by 2 independent reviewers were categorized according to their population. The primary outcome was the proportion of patients with a favourable overall, physical, cognitive, social-emotional or adaptive functional outcome or instrument score, within the first year after discharge. Where ≥ 2 studies have similar populations and instruments, we performed proportional meta-analyses to describe favourable functional outcomes at < 6 months, 6 and 12 months after critical illness.
Results: We reviewed 4216 unique title and abstracts, 73 studies met inclusion criteria to date. Included studies described functioning after traumatic brain injury (47%), cardiac arrest (21%), PICU admission (18%) and other (14%). Function was described using 27 different instruments; 10 overall, 7 cognitive, 6 adaptive, 2 motor and 2 social-emotional. Studies reported function at baseline (58%), < 6 months (53%), at 6 months (58%) and 53% at 12 months. Preliminary meta-analyses indicate that the proportion of children with a favourable functional outcome after in hospital cardiac arrest (PCPC) and TBI (GOS or GOS-E) was 0.73 (0.65-0.8) n=138 and 0.51(0.41-0.61) n=145 < 6months and 0.78 (0.72-0.83) n=203 and 0.85 (0.72-0.98) n=80 at 12 months respectively.
Conclusion: This is the first systematic review with meta-analysis synthesizing the trajectory of diverse functional outcomes after pediatric critical illness across PICU populations