Health-Related Quality of Life Following Delirium in the PICU*

Abstract

To evaluate whether delirium during pediatric critical illness is associated with post-discharge health-related quality of life. DESIGN: Retrospective cohort study. SETTING: Academic tertiary care center. PATIENTS: Children 1 month to 18 years old admitted to the PICU or cardiac ICU and enrolled in the Seattle Children's Hospital Outcomes Assessment Program. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Delirium was assessed twice daily using the Cornell Assessment of Pediatric Delirium; a score greater than or equal to 9 (with fluctuating level of arousal for children with developmental disability) indicated delirium. Baseline (pre-admission) and post-discharge health-related quality of life were assessed by the Pediatric Quality of Life Inventory (Mapi Research Trust, Lyon, France) or the Functional Status II-R (for children with developmental disability). Among 534 patients, delirium was common (44%), as was clinically important decline in health-related quality of life (≥ 4.5 points) from baseline to follow-up (22%), measured at median 6.6 weeks post-hospital discharge (interquartile range, 5.1-8.5). On univariate analysis, children with delirium had similar likelihood of health-related quality of life decline compared with those without (25.5% vs 19.7%; p = 0.1). Using multivariable logistic regression adjusting for age, medical complexity, predicted risk of mortality, admission diagnosis, receipt of noninvasive ventilation, hospital length of stay, time to follow-up, and parent age, delirium was independently associated with health-related quality of life decline among children assessed by the Pediatric Quality of Life Inventory (adjusted odds ratio, 2.0; 95% CI, 1.1-3.5). Among children evaluated with the Functional Status II-R, delirium was not independently associated with health-related quality of life decline (odds ratio, 1.4; 95% CI, 0.6-3.2). In both groups, longer time to follow-up was also independently associated with improvements in health-related quality of life.CONCLUSIONS: Delirium during the ICU stay is associated with decline in health-related quality of life from baseline to post-discharge follow-up among children assessed by the Pediatric Quality of Life Inventory, who were generally characterized by normal baseline cognitive function and less medical comorbidity. This association was not present among children assessed by the Functional Status II-R, potentially due to their higher overall risk of health-related quality of life decline, or other clinical differences that modify the effects of delirium in this group. KEY WORDS: critical care outcomes; delirium; developmental disabilities; follow-up studies; health-related quality of life; intensive care units, pediatric C hildren surviving critical illness commonly experience new morbidity following the ICU stay (1, 2). Post-ICU morbidity is multifaceted, including effects on physical, cognitive, and psychosocial functioning (3, 4). These effects are important to both patients and clinicians

The association of severe pain experienced in the pediatric intensive care unit and postdischarge health‐related quality of life: A retrospective cohort study

“…The total scores were transformed to a linear scale ranging from 0–100, with higher scores indicating better HRQL. A numeric score assessed by either scale indicated the same HRQL consistent with prior PICU outcomes research 5,18–19 …”

“…The OAP collected HRQL data for all consenting participants admitted to the PICU from December 2011 to February 2017. The OAP has been used to examine the associations between HRQL and critical illness and has been described in detail in prior publications 5–6 . Seattle Children's is a freestanding academic children's hospital with 334 inpatient beds, including 32 PICU beds.…”

“…The OAP has been used to examine the associations between HRQL and critical illness and has been described in detail in prior publications. [5][6] Seattle Children's is a freestanding academic children's hospital with 334 inpatient beds, including 32 PICU beds. This study was approved by the Seattle Children's Hospital Institutional Review Board (STUDY00001153, MOD00007155).…”

“…A numeric score assessed by either scale indicated the same HRQL consistent with prior PICU outcomes research. 5,[18][19] The primary outcome was postdischarge HRQL defined as a continuous variable. As a secondary outcome, we evaluated postdischarge emotional functioning and physical functioning subdomain scores for patients with PedsQL™ data.…”

Implementation of a Delirium Bundle for Pediatric Intensive Care Patients

“…Data to long-term outcomes associated with pediatric delirium are rare. Two authors found an association between delirium during the PICU stay with decline in health-related quality of life (10,11). Evidence on measures to prevent and manage delirium is urgently needed.…”