Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literature for case definitions of pediatric CCI and case definitions of prolonged PICU admission and to explore the methodologies used to derive these definitions.DATA SOURCES: Four electronic databases (Ovid Medline, Embase, CINAHL, and Web of Science) from inception to March 3, 2021.
STUDY SELECTION:We included studies that provided a specific case definition for CCI or prolonged PICU admission. Crowdsourcing was used to screen citations independently and in duplicate. A machine-learning algorithm was developed and validated using 6,284 citations assessed in duplicate by trained crowd reviewers. A hybrid of crowdsourcing and machine-learning methods was used to complete the remaining citation screening.
DATA EXTRACTION:We extracted details of case definitions, study demographics, participant characteristics, and outcomes assessed.DATA SYNTHESIS: Sixty-seven studies were included. Twelve studies (18%) provided a definition for CCI that included concepts of PICU length of stay (n = 12), medical complexity or chronic conditions (n = 9), recurrent admissions (n = 9), technology dependence (n = 5), and uncertain prognosis (n = 1). Definitions were commonly referenced from another source (n = 6) or opinion-based (n = 5). The remaining 55 studies (82%) provided a definition for prolonged PICU admission, most frequently greater than or equal to 14 (n = 11) or greater than or equal to 28 days (n = 10). Most of these definitions were derived by investigator opinion (n = 24) or statistical method (n = 18). CONCLUSIONS: Pediatric CCI has been variably defined with regard to the concepts of patient complexity and chronicity of critical illness. A consensus definition is needed to advance this emerging and important area of pediatric critical care research.
This document aims to provide an updated guideline for the diagnosis and management of acute gastroenteritis in pediatrics, as this disease is one of the main causes of consultations and hospitalizations. By performing an exhaustive review of the literature to produce a useful tool, this proposal aims to reduce the impact of the disease incidence, morbidity and mortality. The goal of gastroenteritis treatment is to prevent dehydration and electrolyte imbalance that it can produce, with adequate liquids, oral rehydration salts and maintenance of oral feeding. The causes of this disease are mostly viral and the criteria for antibiotic use is controversial. Treatment modalities to reduce the time of illness as well as the frequency of diarrhea are, in many cases, currently under study; therefore, guided, structured and systematized management will ensure the successful treatment of gastroenteritis in most children.
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