Feature Articles

Long-Term Outcome of PICU Patients Discharged With New, Functional Status Morbidity

Pollack, Murray M. MD¹; Banks, Russell MS²; Holubkov, Richard PhD²; Meert, Kathleen L. MD³

¹ Department of Pediatrics, Children’s National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, DC.

² Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

³ Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063114 and U01HD049934. UG1HD083171, UG1HD083166, and UG1HD083170.

Drs. Pollack’s, Carcillo’s, and Priestley’s institutions received funding from the National Institutes of Child Health and Human Development. Drs. Pollack, Banks, Holubkov, Meert, Bolton, Carcillo, Newth, Priestley, and Siems received support for article research from the National Institutes of Health (NIH). Drs. Banks, Holubkov, Meert, and Siems’ institutions received funding from the NIH. Dr. Holubkov received funding from Pfizer (data and safety monitoring board [DSMB]), Revance (DSMB), Physicians Committee for Responsible Medicine (Biostatistical consulting), Medimmune (DSMB), and DURECT Corporation (biostatistical consulting). Dr. Newth received funding from Philips Research North America and Hamilton Medical. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Pediatric Critical Care Medicine 22(1):p 27-39, January 2021. | DOI: 10.1097/PCC.0000000000002590

Abstract

Objectives:

To determine the long-term (> 6 mo) functional status of PICU patients with significant new functional morbidities at hospital discharge.

Design:

Longitudinal cohort followed-up using structured chart reviews of electronic health records.

Setting:

Electronic health records of former PICU patients at seven sites.

Patients:

Randomly selected patients from the Trichotomous Outcome Prediction in Critical Care study discharged from the hospital with new functional status morbidity who had sufficient electronic health record data to determine functional status.

Interventions:

None.

Measurements and Main Results:

Long-term functional status was measured with the Functional Status Scale and categorized by comparison to hospital discharge Functional Status Scale. Improvement or new morbidity was based on a change in Functional Status Scale of greater than or equal to 2 in a single domain. Overall, 56% (n = 71) improved, 15% (n = 19) did not change, 9% (n = 11) developed a new morbidity, and 21% (n = 26) died. The shortest median follow-up time from PICU discharge was 1.4 years for those who died and the longest was 4.0 years for those improved. Functional status at baseline (pre-acute illness) was different among the outcome groups with those that improved having the highest frequency of baseline normal status or only mild dysfunction. Of the long-term survivors with improvement, 82% (n = 58) improved to normal status or mild dysfunction, 11% (n = 8) improved to moderate dysfunction, and 7% (n = 5) improved to severe dysfunction. Trauma patients improved and cancer patients died more frequently than other diagnoses. The long-term outcome groups were not associated with hospital discharge functional status.

Conclusions:

A majority of PICU survivors discharged with significant new functional morbidity with follow-up after 6 or more months improved, many to normal status or only mild dysfunction, while 29% died or developed new morbidity. Of the long-term survivors, 70% had significant improvement after a median follow-up time of 4.0 years.

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Long-Term Outcome of PICU Patients Discharged With New, Functional Status Morbidity