Long-term functional outcomes of children after critical illnesses: A cohort study.

OBJECTIVE: To assess children's functional outcomes one year after critical illness and identify which factors influenced these functional outcomes. DESIGN: Ambispective cohort study. SETTING: Pediatric intensive care unit (PICU) in a tertiary academic center. PARTICIPANTS: Children (1 month-17-year-old) and their caregivers. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic, clinical, and functional status. RESULTS: Of 242 patients screened, 128 completed the year follow-up. These children had significant changes in functional status over time (p<0.001). The functional decline occurred in 62% of children at discharge and, after one year, was persistent in 33%. Age>12 months was a protective factor against poor functional outcomes in two regression models (p<0.05). A moderately abnormal functional status and a severely/very severely abnormal functional status at discharge increased the risks of poor functional outcomes by 4.14 (95% CI 1.02-16.72; p=0.04), and 4.76 (CI 95% 1.19-19.0; p=0.02). A functional decline at discharge increased by 6.86 (95%CI: 2.16-21.79; p=0.001) the risks of children's long-term poor functional outcomes, regardless of the FSS scores. CONCLUSION: This is the first study evaluating long-term functional outcomes after pediatric critical illnesses in Latin America. Our findings show baseline data and raise relevant questions for future multicentre studies in this field in Latin America, contributing to a better understanding of the effects of critical illnesses on long-term functional outcomes in children.

Long-term functional outcomes of children after critical illnesses: A cohort study / Resultados funcionales a largo plazo de los niños después de enfermedades críticas: un estudio de cohorte

Objective To assess children's functional outcomes one year after critical illness and identify which factors influenced these functional outcomes. Design Ambispective cohort study. Setting Pediatric intensive care unit (PICU) in a tertiary academic center. Participants Children (1 month–17-year-old) and their caregivers. Interventions None. Main variables of interest Demographic, clinical, and functional status. Results Of 242 patients screened, 128 completed the year follow-up. These children had significant changes in functional status over time (p<0.001). The functional decline occurred in 62% of children at discharge and, after one year, was persistent in 33%. Age>12 months was a protective factor against poor functional outcomes in two regression models (p<0.05). A moderately abnormal functional status and a severely/very severely abnormal functional status at discharge increased the risks of poor functional outcomes by 4.14 (95% CI 1.02–16.72; p=0.04), and 4.76 (CI 95% 1.19–19.0; p=0.02). A functional decline at discharge increased by 6.86 (95%CI: 2.16-21.79; p=0.001) the risks of children's long-term poor functional outcomes, regardless of the FSS scores. Conclusion This is the first study evaluating long-term functional outcomes after pediatric critical illnesses in Latin America. Our findings show baseline data and raise relevant questions for future multicentre studies in this field in Latin America, contributing to a better understanding of the effects of critical illnesses on long-term functional outcomes in children (AU)

Objetivo Evaluar los resultados funcionales de los niños un año después de la enfermedad crítica e identificar qué factores influyeron en estos resultados funcionales. Diseño Estudio de cohorte ambispectivo. Entorno Unidad de Cuidados Intensivos Pediátricos (UCIP) de un centro académico terciario. Participantes Niños (1 mes-17 años) y sus cuidadores. Intervenciones Ninguna. Principales variables de interés Estado demográfico, clínico y funcional. Resultados De 242 niños examinados, 128 completaron el seguimiento. Estos niños y adolescentes cambiaron su estado funcional significativamente con el tiempo (p<0,001). El deterioro funcional ocurrió en el 62% de los niños al momento del alta y, después de un año, fue persistente en el 33%. La edad >12 meses fue un factor protector contra malos resultados funcionales en dos modelos de regresión (p<0,05). Un estado funcional moderadamente anormal y severamente/muy severamente anormal al alta aumentó el riesgo de resultados funcionales deficientes en 4,14 (IC95% 1,02-16,72; p=0,04) y 4,76 (IC95% 1,19-19,0; p=0,02). Una disminución funcional en el momento del alta aumentó los riesgos de resultados funcionales deficientes a largo plazo en 6,86 (IC95% 2,16-21,79; p=0,001), independientemente de las puntuaciones de FSS. Conclusión Este es el primer estudio que evalúa los resultados funcionales a largo plazo después de enfermedades críticas pediátricas en América Latina. Nuestros datos son básicos y plantean preguntas relevantes para futuros estudios multicéntricos en América Latina y pueden contribuir a una mejor comprensión de los efectos de enfermedades críticas en los resultados funcionales a largo plazo en niños (AU)