Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care

Abstract

Pediatric neurocritical care (PNCC) outcomes research is scarce. We aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. METHODS: We conducted a 2-year observational study of children aged 0 to 18 years admitted to the ICU with a primary neurologic diagnosis (N 5 325). Primary outcomes were death and change in FSS from preadmission baseline to discharge. New disability was defined as an FSS change of $1 from baseline, and severe disability was defined as an FSS change of $3. Categorical results are reported as relative risk (RR) with 95% confidence interval (CI). RESULTS: Thirty (9%) patients died. New disability (n 5 103; 35%) and severe disability (n 5 37; 13%) were common in PNCC survivors. New disability (range 14%-54%) and severe disability (range 3%-33%) outcomes varied significantly among primary diagnoses (lowest in status epilepticus; highest in infectious and/or inflammatory and stroke cohorts). Disability occurred in all FSS domains: mental status (15%), sensory (52%), communication (38%), motor (48%), feeding (40%), and respiratory (12%). Most (64%) patients with severe disability had changes in $3 domains. Requiring critical care interventions (RR 2.1; 95% CI 1.5-3.1) and having seizures (RR 1.5; 95% CI 1.1-2.0) during hospitalization were associated with new disability. CONCLUSIONS: PNCC patients have high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability are affected, underscoring the ongoing multidisciplinary health care needs of survivors. Our study quantified hospital outcomes of PNCC patients that can be used to advance future research in this vulnerable population.

A Mixed-Methods Quasi-Experimental Study on Perspectives Among Physicians and Nurses Regarding Use of Palliative Care Teams in the Pediatric Intensive Care Unit After Out-of-Hospital Cardiac Arrest

“…Although outcomes of OHCA are known to vary by region in the United States, 2 our population is likely generalizable to other academic tertiary children’s hospitals. Over the past 2 years, 32% of pediatric patients admitted to OHSU Doernbecher Children’s Hospital PICU survived to discharge after initial presentation with OHCA, 4 similar to prior multicenter studies. 1 -3 Additionally, our data showed high numbers of children who survived with impaired functional status (42%) 4 and highlight the need for ongoing care after discharge.…”

“…Over the past 2 years, 32% of pediatric patients admitted to OHSU Doernbecher Children’s Hospital PICU survived to discharge after initial presentation with OHCA, 4 similar to prior multicenter studies. 1 -3 Additionally, our data showed high numbers of children who survived with impaired functional status (42%) 4 and highlight the need for ongoing care after discharge. Palliative care teams are primed to provide this ongoing care, but the multiple barriers identified in our study precluded consultation in the majority of OHCA patients.…”

“…Recent data from OHSU indicate approximately 20 patients per year are admitted to the PICU with OHCA, 32% survive to discharge, and only 19% survive at their functional baseline. 4 In the 2.5 years prior to and during this study, only 4% of OHCA patients at our institution received a palliative care consult at any point during admission.…”

“…1,3 Recent data from Oregon Health & Science University (OHSU) showed less than 1 in 5 survivors of OHCA were discharged at their functional baseline, highlighting the ongoing medical needs of most survivors and challenges faced by their families after discharge. 4 Although all children in the PICU receive comprehensive care, this care often does not extend beyond the hospital stay without specialty team involvement during admission. Despite its growing presence at most tertiary pediatric hospitals, palliative care resources are often underutilized but are primed to provide the longitudinal support needed by PICU survivors and families both during admission and after discharge.…”

Correlação dos fatores sociodemográficos e clínicos com alterações da funcionalidade em crianças hospitalizadas

“…Recentemente, um instrumento especifico para avaliar a funcionalidade, a Functional Status Scale (FSS), passou pelo processo de validação na população brasileira e desde então tem sido amplamente utilizada. 6,9,10 Esse instrumento foi desenvolvido com base conceitual em escalas de atividades de vida diária e de comportamento adaptativo, e seu objetivo é avaliar os desfechos funcionais de pacientes pediátricos hospitalizados. 6,9,10 A FSS é um instrumento apropriado para uma ampla faixa etária, considerado de fácil aplicação, baixo custo e confiável.…”