Anne Stormorken, MD
attending
Rainbow Babies & Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Steven Shein, MD, FCCM
Rainbow Babies & Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Title: Functional Decline Following ICU Admission of the Critically Ill Child
Introduction: While advances in critical care medicine have resulted in a decrease in mortality, data relevant to long-term morbidity and functional decline of children admitted to the Pediatric Intensive Care Unit (PICU) are limited.
Methods: With IRB approval, we prospectively enrolled children aged 2 months (corrected for gestational age if born >2 weeks prematurely) to 18 years, admitted to the PICU for greater than 24 hours in a single hospital, with expected survival. A validated, age-appropriate tool (Ages & Stages Questionnaires, Third Edition [ASQ] or Pediatric Evaluation of Disability Inventory-Computer Adaptive Test [PEDI-CAT]) was used to measure pre-illness baseline developmental status. Repeat testing was performed 1 month post-ICU discharge. A “decline” was defined by at ≥10-point decrease from baseline in any ASQ domain (e.g. Communication, Gross Motor, etc.), or by a ≥1-tier decrease from baseline (e.g. 50th-75th percentile to 25th-50th) in any PEDI-CAT domain. “Substantial decline” was defined by decline in ≥2 domains. Descriptive analyses are reported.
Results: Of 250 patients (median age 2.5 years, 38% female), 115 have completed evaluation at 1 month after discharge. Of these, 28% declined from baseline and 16% met criteria for substantial decline. Among children who had decline observed using ASQ, a decline was most commonly seen in the Gross Motor domain (37%), Among children who had a decline observed using PEDI-CAT, a decline was most commonly seen in the Mobility Score (49%).
Conclusions: In a convenience sample of critically ill children, there was evidence of functional impairment following ICU admission. Decline was most commonly seen in motor function. Further studies are needed to fully describe outcomes of critically ill children and to identify modifiable risk factors in order to minimize morbidity in this patient population.