Functional Outcomes of Children on Discharge from a Paediatric Intensive Care Unit

Abstract

Background Paediatric critical care is a constantly evolving field of health care and has changed considerably over the past two decades. Improved care and paediatric intensive care unit (PICU) protocols have resulted in increased survival rates of patients presenting to PICU. However, this also means that the number of surviving patients with long term functional impairments has increased. Research acknowledges that children are at risk of recurrent serious acute illness and more PICU admissions, yet how children and their families recover after surviving a critical illness is poorly understood. Objective This cross-sectional study aimed to assess the functional outcomes of paediatric patients on discharge from a private hospital PICU using the Functional Status Scale (FSS). The objectives included describing demographic characteristics and clinical characteristics of participants admitted to a particular PICU in Gauteng, South Africa. Secondly to establish functional outcomes in six domains – mental status, sensory, motor function, communication, feeding, and respiratory function, at the time of discharge from PICU, using the FSS and furthermore, to investigate the association between admission diagnosis, age, sex, length of stay (LOS), duration of ventilation of participants and functional outcomes, at the time of PICU discharge. Methods Conducted between May 2023 and December 2023, this study included paediatric patients aged 1 month to 13 years, where the appropriate consent and assent was obtained. All patients were admitted to a private hospital PICU, in Gauteng South Africa, for more than 24 hours, to meet the inclusion criteria. The FSS (total score = 30; sub scores per domain = 5), which assesses functional status across six domains, was administered on the day of discharge from PICU. Data capturing was conducted by the primary investigator and statistical analysis was done by a senior data scientist using MATLAB R2024a and Spearman correlation co-efficient to draw correlations between variables. using Spearman correlation co-efficient to draw correlations between variables. iv Results The cohort consisted of 28 participants that completed the study. Based on the findings of this research it was concluded that, within this cohort the median (IQR) age of the participants was 24 (14-72) months old and the median (IQR) LOS was 21 (8-32) days. The sample was equally distributed for males (50%) and females (50%). Most common causes for admission were either respiratory (n =11; 39.3%) or neurological (n=11;39.3%) in nature and this was the first PICU admission for 64% (n = 18) of cohort. The FSS mean and median overall score was eight (8/30). The highest mean scores were noted in the mental status and motor function domains and 36% (n = 10) of participants had a score of more than or equal to nine indicating ‘mild’ to ‘moderate’ dysfunction. Common trends within the correlations, included that longer duration of ventilation results in higher FSS mental status scores (r =0.74; p = <0.01; worse dysfunction); longer duration of ventilation results in higher FSS scores for the respiratory domain (r = 0.74; p = 0.0005; worse dysfunction) and lastly, the longer PICU LOS the higher the FFS motor function scores (r = 0.61; p = 0.0007; worse dysfunction). Conclusion Children admitted to this particular PICU are most likely to be younger than or equal to 24 months old and have a longer LOS (median = 21 days). Evaluation of functional status indicated higher scores in the mental status and motor function domains of the FSS and an overall score falling within either the normal or mild dysfunction category. Participants with greater functional impairments had longer PICU stays and longer duration of mechanical ventilation. The FSS provided a rapid and effective assessment of functional status in PICU patients. The observed correlations suggest that prolonged duration of ventilation and extended PICU stay are associated with increased functional dysfunction, particularly in mental status, respiratory and motor domains. This is important to consider when re-evaluating PICU protocols such as ventilation weaning protocols and discharge criteria. The FSS’s ability to quickly assess multiple domains is a valuable tool for evaluating post-PICU functional status, to allow for early identification of patients who are at high risk for developing medium-to long -term disability.