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Observational Study
. 2019 Dec;9(12):958-966.
doi: 10.1542/hpeds.2019-0173.

Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care

Cydni N Williams  1   2 , Carl O Eriksson  2 , Aileen Kirby  2 , Juan A Piantino  3   4 , Trevor A Hall  3   5 , Madison Luther  2 , Cindy T McEvoy  6
Affiliations
Observational Study

Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care

Cydni N Williams et al. Hosp Pediatr. 2019 Dec.

Abstract

Objectives: Pediatric neurocritical care (PNCC) outcomes research is scarce. We aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses.

Methods: We conducted a 2-year observational study of children aged 0 to 18 years admitted to the ICU with a primary neurologic diagnosis (N = 325). Primary outcomes were death and change in FSS from preadmission baseline to discharge. New disability was defined as an FSS change of ≥1 from baseline, and severe disability was defined as an FSS change of ≥3. Categorical results are reported as relative risk (RR) with 95% confidence interval (CI).

Results: Thirty (9%) patients died. New disability (n = 103; 35%) and severe disability (n = 37; 13%) were common in PNCC survivors. New disability (range 14%-54%) and severe disability (range 3%-33%) outcomes varied significantly among primary diagnoses (lowest in status epilepticus; highest in infectious and/or inflammatory and stroke cohorts). Disability occurred in all FSS domains: mental status (15%), sensory (52%), communication (38%), motor (48%), feeding (40%), and respiratory (12%). Most (64%) patients with severe disability had changes in ≥3 domains. Requiring critical care interventions (RR 2.1; 95% CI 1.5-3.1) and having seizures (RR 1.5; 95% CI 1.1-2.0) during hospitalization were associated with new disability.

Conclusions: PNCC patients have high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability are affected, underscoring the ongoing multidisciplinary health care needs of survivors. Our study quantified hospital outcomes of PNCC patients that can be used to advance future research in this vulnerable population.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Outcomes of children receiving neurocritical care. The chart shows percentages of patients within each diagnosis, with the outcomes of death and new disability being measured by the FSS score change from baseline at hospital discharge.
FIGURE 2
FIGURE 2
FSS change among survivors with new disability. Distribution of FSS total score change from baseline at hospital discharge among diagnosis categories.
See this image and copyright information in PMC

References

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