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. 2015 May;16(4):310-8.
doi: 10.1097/PCC.0000000000000362.

Functional recovery following critical illness in children: the "wee-cover" pilot study

Karen Choong  1 , Samah Al-Harbi, Katie Siu, Katie Wong, Ji Cheng, Burke Baird, David Pogorzelski, Brian Timmons, Jan-Willem Gorter, Lehana Thabane, Mary Khetani; Canadian Critical Care Trials Group
Collaborators, Affiliations

Functional recovery following critical illness in children: the "wee-cover" pilot study

Karen Choong et al. Pediatr Crit Care Med. 2015 May.

Abstract

Objective: To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children.

Design: Prospective pilot study.

Setting: Single-center PICU at McMaster Children's Hospital, Hamilton, Canada.

Patients: Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed rest during the first 48 hours of PICU admission, and a minimum 48-hour PICU length of stay, were eligible. Patients transferred from a neonatal ICU prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study, were excluded.

Interventions: None.

Measurements and main results: The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity, and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory and the Participation and Environment Measure for Children and Youth. Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, and follow-up rates were 93% at 3 months and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status and severity of illness.

Conclusion: Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multicenter study evaluating functional recovery in this population.

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Conflict of interest statement

The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1
Figure 1. Patient Flow
PICU Pediatric Intensive Care Unit
Figure 2
Figure 2. Functional Status (PEDI*) over time
The boxplots represent the median and IQR while the tails indicate the minimum and maximum. PEDI, Pediatric Evaluation of Disability Inventory (10); measures motor capability via the Functional Skills Scale (FSS), and motor performance via the Caregiver assistance scale (CAS), in the self-care and mobility domains respectively. Scores are scaled 0-100, with a higher score indicating better function. Baseline functional limitation was defined as patients with a Pediatric Overall Performance Category score > 1.
Figure 3
Figure 3. Proportion of patients recovering to baseline functional status at 3 and 6 months post PICU discharge
Baseline functional limitation was defined as patients with a Pediatric Overall Performance Category (POPC) score > 1.
See this image and copyright information in PMC

Comment in

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