Physical, Cognitive, Emotional, and Social Health Outcomes of Children in the First 6 Months After Childhood Critical Illness: A Prospective Single-Center Study.

Abstract

Objectives: To describe physical, cognitive, emotional, and social health outcomes of children and their trajectory in the first 6 months after PICU discharge.

Design: Prospective, longitudinal observational cohort study.

Setting: PICU in a tertiary pediatric hospital in Singapore from January 2021 to June 2022.

Patients: One hundred thirty-five children (1 mo to 18 yr), admitted for greater than or equal to 48 hours with at least one organ dysfunction and received PICU therapy.

Interventions: None.

Measurements and main results: Serial self/parent proxy-reported assessments were obtained at: PICU admission, PICU discharge, and 1, 3, and 6 months after PICU discharge. The Pediatric Quality of Life Inventory (PedsQL) scale, Functional Status Scale (FSS), and measures of post-traumatic stress disorder (PTSD) using the Young Child PTSD Screen and the Child and Adolescent PTSD Screen-Parent Version were used. Trajectory groups were identified using group-based trajectory model. One hundred thirty-five children (mean [sd] age, 5.6 yr [5.5 yr]) were recruited. Seventy-eight (52%) were male. The mean (sd) Pediatric Index of Mortality III score was 3.2 (4.1) and PICU length of stay was 10.0 days (21.0 d). The mean (sd) PedsQL total scores were 66.5 (21.1) at baseline, 69.7 (21.4), 75.6 (19.7), and 78.4 (19.8) at 1, 3, and 6 months after PICU discharge, respectively. Overall, the PedsQL and FSS plateaued at 3 months. Our model revealed three distinct trajectory groups. Seventeen and 103 children in the mild and moderate trajectory groups, respectively, demonstrated recovery to baseline. Fifteen children in the severe trajectory group were older in age (mean [sd] 8.3 yr [6.4 yr]), with higher proportion (11/15) of preexisting illness. Five of 15 children in the severe group experienced posttraumatic stress syndrome (PTSS) at 6 months post-discharge.

Conclusions: In our cohort of PICU patients, we found three unique trajectory groups. Children in the severe group were older, more likely to have preexisting conditions and at increased risk for PTSS. Early identification and intervention may improve recovery in patients with severe PICU trajectories.