Overall Health Following Pediatric Critical Illness: A Scoping Review of Instruments and Methodology

Carlton, Erin; Pinto, Neethi; Smith, McKenna; Fink, Ericka L.; Watson, R. Scott; Hoehn, K. Sarah; Marupudi, Neelima; Dervan, Leslie A.; Lackey, Mellanye; Ringwood, Melissa; Maddux, Aline B

doi:10.1097/pcc.0000000000002800

Cited by 12 publications

(13 citation statements)

References 27 publications

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“…Risk factors associated with acquiring a new device class after discharge were preexisting functional impairments, treatment with chemotherapy or radiotherapy, and mechanical ventilation durations longer than 9 days. Trials of PICU-specific interventions (e.g., rehabilitation or ventilation strategies) targeting a high-risk cohort identified by these factors may be effective in decreasing morbidities requiring new device acquisition, an important and patient-centered long-term outcome (17, 25–27).…”

Section: Discussionmentioning

confidence: 99%

“…18 (11-25) 15(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) 15(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) 17(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) PELOD-2 = Pediatric Logistic Organ Dysfunction-2. a Area Deprivation Index was unavailable for 58 patients.b Patient is categorized based on data collected within the Pediatric Health Information System (PHIS) for the 3 yr prior to Life After Pediatric Sepsis Evaluation index ICU admission.…”

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confidence: 99%

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Health Resource Use in Survivors of Pediatric Septic Shock in the United States

Maddux

Zimmerman

Banks

et al. 2022

Pediatric Critical Care Medicine

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To evaluate postdischarge health resource use in pediatric survivors of septic shock and determine patient and hospitalization factors associated with health resource use. DESIGN:Secondary analyses of a multicenter prospective observational cohort study. SETTING:Twelve academic PICUs. PATIENTS:Children greater than or equal to 1 month and less than 18 years old hospitalized for community-acquired septic shock who survived to 1 year. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:For 308/338 patients (91%) with baseline and greater than or equal to one postdischarge survey, we evaluated readmission, emergency department (ED) visits, new medication class, and new device class use during the year after sepsis. Using negative binomial regression with bidirectional stepwise selection, we identified factors associated with each outcome. Median age was 7 years (interquartile range, 2-13), 157 (51%) had a chronic condition, and nearly all patients had insurance (private [n = 135; 44%] or government [n = 157; 51%]). During the year after sepsis, 128 patients (42%) were readmitted, 145 (47%) had an ED visit, 156 (51%) started a new medication class, and 102 (33%) instituted a new device class. Having a complex chronic condition was independently associated with readmission and ED visit. Documented infection and higher sum of Pediatric Logistic Organ Dysfunction--2 hematologic score were associated with readmission, whereas younger age and having a noncomplex chronic condition were associated with ED visit. Factors associated with new medication class use were private insurance, neurologic insult, and longer PICU stays. Factors associated with new device class use were preadmission chemotherapy or radiotherapy, presepsis Functional Status Scale score, and ventilation duration greater than or equal to 10 days. Of patients who had a new medication or device class, most had a readmission (56% and 61%) or ED visit (62% and 67%). CONCLUSIONS:Children with septic shock represent a high-risk cohort with high-resource needs after discharge. Interventions and targeted outcomes to mitigate postdischarge resource use may differ based on patients' preexisting conditions.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Health Resource Use in Survivors of Pediatric Septic Shock in the United States

Maddux

Zimmerman

Banks

et al. 2022

Pediatric Critical Care Medicine

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“…Clinicians are adopting these measures into clinical practice, and PROMIS measures are integrated into some Epic eMR systems (39,40). There is interest in expanding the use of validated and standardized patient-reported outcome measures and health-related quality of life questionnaires in pediatric critical care medicine (41)(42)(43)(44)(45)(46). Further studies, such as ours, are needed to determine the most appropriate measures of overall health in the pediatric critically ill population (42,45).…”

Section: Discussionmentioning

confidence: 99%

Adverse Childhood Experiences and Patient-Reported Outcome Measures in Critically Ill Children

et al. 2022

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Adverse childhood experiences (ACEs) are linked to adverse health outcomes for adults and children in the United States. The prevalence of critically ill children who are exposed to ACEs is not known. Our objective was to compare the frequency of ACEs of critically ill children with that of the general pediatric population of Georgia and the United States using publicly available National Survey of Children’s Health (NSCH) data. The impact of ACEs on patient-reported outcome measures of emotional, social, and physical health in critically ill children is not known. We sought to determine whether a higher total number of ACEs was associated with poorer patient-reported measures of emotional, social, and physical health. We conducted a prospective cross-sectional study of children < 18 years of age who were admitted to a 36-bed free-standing, quaternary academic pediatric intensive care unit in Atlanta, Georgia from June 2020—December 2021. Parents of patients who were admitted to the pediatric intensive care unit completed a survey regarding their child’s ACEs, health care use patterns, and patient-reported outcome measures (PROMIS) of emotional, social, and physical health. Prevalence estimates of ACEs were compared with national and state data from the NSCH using Rao-Scott Chi-square tests. PROMIS measures reported within the PICU cohort were compared with population normed T-scores. The association of cumulative ACEs within the PICU cohort with patient-reported outcomes of emotional, social, and physical health were evaluated with a t-test. Among the 84 participants, 54% had ≥ 1 ACE, 29% had ≥ 2 ACEs, and 10% had ≥ 3 ACEs. Children with ≥ 2 ACEs had poorer anxiety and family relationship T-scores compared to those with ≤ 1 ACE. Given the high burden of ACEs in critically ill children, screening for ACEs may identify vulnerable children that would benefit from interventions and support to mitigate the negative effects of ACEs and toxic stress on emotional, social, and physical health.

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“…When a clinical problem is insufficiently defined or the research priorities have not been fully considered and debated, scoping reviews and consensus conferences can aid in lending clarity to what is known and what future research priorities should be. In the last 3 years, PALISI has focused on aspects of hemopoietic stem-cell transplantation (HCT) (16)(17)(18), transfusion and bleeding (19,20), measuring outcomes (21)(22)(23), and clinical decision support (24). Table 2 shows other examples of consensus conferences and their links to prior or future PALISI Network studies.…”

Section: Scoping Reviews and Consensus Meetingsmentioning

confidence: 99%

Pediatric Acute Lung Injury and Sepsis Investigators (PALISI): Evolution of an Investigator-Initiated Research Network

Randolph

Bembea

Cheifetz

et al. 2022

Pediatric Critical Care Medicine

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The Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network originated over 20 years ago to foster research to optimize the care of critically ill infants and children. Over this period, PALISI has seen two major evolutions: formalization of our network infrastructure and a broadening of our clinical research focus. First, the network is unique in that its activities and meetings are funded by subscriptions from members who now comprise a multidisciplinary group of investigators from over 90 PICUs all over the United States (US) and Canada, with collaborations across the globe. In 2020, the network converted into a standalone, nonprofit organizational structure (501c3), making the PALISI Network formally independent of academic and clinical institutions or professional societies. Such an approach allows us to invest in infrastructure and future initiatives with broader opportunities for fund raising. Second, our research investigations have expanded beyond the original focus on sepsis and acute lung injury, to incorporate the whole field of pediatric critical care, for example, efficient liberation from mechanical ventilator support, prudent use of blood products, improved safety of intubation practices, optimal sedation practices and glucose control, and pandemic research on influenza and COVID-19. Our network approach in each field follows, where necessary, the full spectrum of clinical and translational research, including: immunobiology studies for understanding basic pathologic mechanisms; surveys to explore contemporary clinical practice; consensus conferences to establish agreement about literature evidence; observational prevalence and incidence studies to measure scale of a clinical issue or question; case control studies as preliminary best evidence for design of definitive prospective studies; and, randomized controlled trials for informing clinical care. As a research network, PALISI and its related subgroups have published over 350 peer-reviewed publications from 2002 through September 2022.

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Overall Health Following Pediatric Critical Illness: A Scoping Review of Instruments and Methodology

Cited by 12 publications

References 27 publications

Health Resource Use in Survivors of Pediatric Septic Shock in the United States

Health Resource Use in Survivors of Pediatric Septic Shock in the United States

Adverse Childhood Experiences and Patient-Reported Outcome Measures in Critically Ill Children

Pediatric Acute Lung Injury and Sepsis Investigators (PALISI): Evolution of an Investigator-Initiated Research Network

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