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. 2020 Dec;48(12):e1313-e1321.
doi: 10.1097/CCM.0000000000004595.

Postdischarge Outcome Domains in Pediatric Critical Care and the Instruments Used to Evaluate Them: A Scoping Review

Aline B Maddux  1 , Neethi Pinto  2 , Ericka L Fink  3 , Mary E Hartman  4 , Sholeen Nett  5 , Katherine Biagas  6 , Elizabeth Y Killien  7 , Leslie A Dervan  7   8 , LeeAnn M Christie  9 , Peter M Luckett  10 , Laura Loftis  11 , Mellanye Lackey  12 , Melissa Ringwood  13 , McKenna Smith  13 , Lenora Olson  13 , Sam Sorenson  13 , Kathleen L Meert  14 , Daniel A Notterman  15 , Murray M Pollack  16 , Peter M Mourani  1 , R Scott Watson  7   17 ; Pediatric Outcomes STudies after PICU (POST-PICU) and PICU-COS Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Networks
Affiliations

Postdischarge Outcome Domains in Pediatric Critical Care and the Instruments Used to Evaluate Them: A Scoping Review

Aline B Maddux et al. Crit Care Med. 2020 Dec.

Abstract

Objectives: Assessing outcomes after pediatric critical illness is imperative to evaluate practice and improve recovery of patients and their families. We conducted a scoping review of the literature to identify domains and instruments previously used to evaluate these outcomes.

Design: Scoping review.

Setting: We queried PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials Registry for studies evaluating pediatric critical care survivors or their families published between 1970 and 2017. We identified articles using key words related to pediatric critical illness and outcome domains. We excluded articles if the majority of patients were greater than 18 years old or less than 1 month old, mortality was the sole outcome, or only instrument psychometrics or procedural outcomes were reported. We used dual review for article selection and data extraction and categorized outcomes by domain (overall health, emotional, physical, cognitive, health-related quality of life, social, family).

Subjects: Manuscripts evaluating outcomes after pediatric critical illness.

Interventions: None.

Measurements and main results: Of 60,349 citations, 407 articles met inclusion criteria; 87% were published after 2000. Study designs included observational (85%), interventional (7%), qualitative (5%), and mixed methods (3%). Populations most frequently evaluated were traumatic brain injury (n = 96), general pediatric critical illness (n = 87), and congenital heart disease (n = 72). Family members were evaluated in 74 studies (18%). Studies used a median of 2 instruments (interquartile range 1-4 instruments) and evaluated a median of 2 domains (interquartile range 2-3 domains). Social (n = 223), cognitive (n = 183), and overall health (n = 161) domains were most frequently studied. Across studies, 366 unique instruments were used, most frequently the Wechsler and Glasgow Outcome Scales. Individual domains were evaluated using a median of 77 instruments (interquartile range 39-87 instruments).

Conclusions: A comprehensive, generalizable understanding of outcomes after pediatric critical illness is limited by heterogeneity in methodology, populations, domains, and instruments. Developing assessment standards may improve understanding of postdischarge outcomes and support development of interventions after pediatric critical illness.

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Figures

Figure 1.
Figure 1.. Number of manuscripts evaluating outcomes after pediatric critical illness and study designs.
The study of outcomes after pediatric critical illness has increased substantially after 2000, with most of the articles using an observational study design.
See this image and copyright information in PMC

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