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Liu G, Xin H, Lin J, Li X, Zhang Y, Wang X, Liao J, Hu R. Analysis of the survival journey and post-traumatic growth process of children and their families following paediatric intensive care unit admission: A grounded theory study. Aust Crit Care 2024:S1036-7314(24)00116-4. [PMID: 38969541 DOI: 10.1016/j.aucc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVES Advances in critical care technology have lowered mortality rates among critically ill individuals. Nonetheless, survivors and their families may develop new physical, mental, cognitive, and social challenges due to paediatric intensive care unit (PICU) treatments, impacting their quality of life. The aim of this study was to investigate the survival journey and post-traumatic growth process of children and their families following PICU admission within the Chinese cultural context. METHODS Twenty-six children who have been or are currently admitted to the PICU, alongside their parents and three PICU nurses, were chosen through purposive and theoretical sampling. Data collection involved face-to-face interviews and observations, with data analysis conducted through continuous comparison, open coding, and selective coding techniques. FINDINGS A model outlining the survival journey and post-traumatic growth process of critically ill children and their families post PICU admission has been established. This model encompasses two central trajectories: an upward trajectory consisting of confusion, charging, action, and sublimation phases and a downward trajectory comprising confusion, doubt and fear, inhibition (including confrontation and avoidance), and drowning phases. CONCLUSIONS Critically ill children and their families encounter diverse survival experiences and psychological journeys following traumatic events in the PICU. The survival experience has alternative upwards or downwards trajectories that are flexible/adaptable. Hence, offering timely psychological support can alter their developmental trajectories and foster post-traumatic growth.
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Affiliation(s)
- Guihua Liu
- Department of Child Health Care, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian 350001, China; The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Huining Xin
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian 350001, China.
| | - Jinling Lin
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Xiaoting Li
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Yuhong Zhang
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Xiaojuan Wang
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Jinhua Liao
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Rongfang Hu
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China.
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Drury KM, Hall TA, Orwoll B, Adhikary S, Kirby A, Williams CN. Exposure to Sedation and Analgesia Medications: Short-term Cognitive Outcomes in Pediatric Critical Care Survivors With Acquired Brain Injury. J Intensive Care Med 2024; 39:374-386. [PMID: 37885235 PMCID: PMC11132562 DOI: 10.1177/08850666231210261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background/Objective: Pediatric intensive care unit (PICU) survivors risk significant cognitive morbidity, particularly those with acquired brain injury (ABI) diagnoses. Studies show sedative and analgesic medication may potentiate neurologic injury, but few studies evaluate impact on survivor outcomes. This study aimed to evaluate whether exposures to analgesic and sedative medications are associated with worse neurocognitive outcome. Methods: A retrospective cohort study was conducted of 91 patients aged 8 to 18 years, undergoing clinical neurocognitive evaluation approximately 1 to 3 months after PICU discharge. Electronic health data was queried for sedative and analgesic medication exposures, including opioids, benzodiazepines, propofol, ketamine, and dexmedetomidine. Doses were converted to class equivalents, evaluated by any exposure and cumulative dose exposure per patient weight. Cognitive outcome was derived from 8 objective cognitive assessments with an emphasis on executive function skills using Principal Components Analysis. Then, linear regression was used to control for baseline cognitive function estimates to calculate a standardized residualized neurocognitive index (rNCI) z-score. Multivariable linear regression evaluated the association between rNCI and medication exposure controlling for covariates. Significance was defined as P < .05. Results: Most (n = 80; 88%) patients received 1 or more study medications. Any exposure and higher cumulative doses of benzodiazepine and ketamine were significantly associated with worse rNCI in bivariate analyses. When controlling for Medicaid, preadmission comorbid conditions, length of stay, delirium, and receipt of other medication classes, receipt of benzodiazepine was associated with significantly worse rNCI (β-coefficient = -0.48, 95% confidence interval = -0.88, -0.08). Conclusions: Exposure to benzodiazepines was independently associated with worse acute phase cognitive outcome using objective assessments focused on executive function skills when controlling for demographic and illness characteristics. Clinician decisions regarding medication regimens in the PICU may serve as a modifiable factor to improve outcomes. Additional inquiry into associations with long-term cognitive outcome and optimal medication regimens is needed.
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Affiliation(s)
- Kurt M. Drury
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University
| | - Benjamin Orwoll
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
| | - Sweta Adhikary
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
- School of Medicine, Oregon Health and Science University
| | - Aileen Kirby
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
| | - Cydni N. Williams
- Department of Pediatrics, Division of Critical Care, Oregon Health & Science University
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University
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Canavera K, Marik P, Schneider NM, Smith J. The Role of Pediatric Psychologists in Critical Care: Lessons Learned and Future Directions in Integrating Mental Health Care Into PICUs. Chest 2024:S0012-3692(24)00398-2. [PMID: 38513964 DOI: 10.1016/j.chest.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Pediatric psychologists are essential staff in the PICU. Their role in caring for critically ill children aligns with clinical practice guidelines for the mental health care needs of this population of patients. This article highlights the role of pediatric psychology in the PICU through illustrative case examples. We discuss lessons learned and future directions for the development and provision of mental health services in PICUs. We address relevant ways for critical care providers to understand the importance of evidence-based psychological care and advocate for the inclusion of psychologists on multidisciplinary PICU teams. As the critical care field continues to focus on an improved understanding of post-intensive care syndrome in pediatrics and the psychological needs of critical care patients, it will be important to consider the vital roles of psychologists and to advocate for improved integration of mental health care in PICUs.
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Affiliation(s)
- Kristin Canavera
- Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA.
| | - Patricia Marik
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
| | - Nicole M Schneider
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jacquelyn Smith
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
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Klapp JM, Hall TA, Riley AR, Janzen D, Williams CN. Post-PICU sleep efficiency and quality of life in infants and toddlers with acquired brain injury. J Clin Sleep Med 2024; 20:75-83. [PMID: 37707302 PMCID: PMC10758560 DOI: 10.5664/jcsm.10798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
STUDY OBJECTIVES We aimed to investigate the use of sleep efficiency (SE) as a measure of sleep disturbance in infants and toddlers with acquired brain injury (ABI) and evaluate associations between SE and child health-related quality of life and family outcomes. METHODS Retrospective cohort study of 101 children ages 3-36 months who survived critical care for ABI. SE was quantified from the Brief Infant Sleep Questionnaire as a ratio of nighttime sleep to total time in bed; poor SE was defined as < 80%. Outcome measures included the Pediatric Quality of Life Inventory Core Total Score (health-related quality of life) and Family Impact Module Total Score. Spearman's correlation quantified associations between SE and outcomes. Multivariable linear regression tested association between poor SE and health-related quality of life controlling for significant covariates (age, diagnosis, comorbidities, worsening Functional Status Scale). RESULTS Following ABI, median SE was 91.7 (interquartile range = 83.3, 95.5). Nineteen (19%) children had poor SE (< 80%). SE correlated significantly with quality of life (Spearman's correlation = .307) and Family Impact Module (Spearman's correlation = .309; both P < .01). When controlling for covariates, poor SE significantly increased risk for lower health-related quality of life (β-coefficient = -7.0; 95% confidence interval= -13.4, -0.6). CONCLUSIONS One in five infants and young children with ABI have poor SE that is associated with poorer child and family health outcomes. Our study underscores the potential importance of sleep following ABI to optimize recovery and the need for additional investigation of SE in infants and young children. CITATION Klapp JM, Hall TA, Riley AR, Janzen D, Williams CN. Post-PICU sleep efficiency and quality of life in infants and toddlers with acquired brain injury. J Clin Sleep Med. 2024;20(1):75-83.
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Affiliation(s)
- Jamie M. Klapp
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Andrew R. Riley
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Darren Janzen
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health & Science University, Portland, Oregon
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Canavera K, Ghafoor S, Fan K, Cheng C, Jeha S, Pui CH, Elliott A, Morrison RR, Jacola LM. Post-PICU Cognitive and Psychological Outcomes in Children Receiving Treatments for Acute Lymphoblastic Leukemia. Pediatr Crit Care Med 2023; 24:e584-e591. [PMID: 38055007 DOI: 10.1097/pcc.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES To examine neurocognitive and psychological outcomes associated with post-PICU admissions in children treated for childhood acute lymphoblastic leukemia (ALL). DESIGN Observational study from October 2007 to March 2017. SETTING Pediatric onco-critical care unit. PATIENTS All patients in this study (n = 296; ages 3-21) were treated for ALL on the St. Jude Total Therapy 16 clinical trial (NCT00549848) from 2007 to 2017. Of these, 104 patients were admitted to the PICU during protocol-directed therapy. All patients completed protocol-directed neurocognitive monitoring prospectively, at the end of cancer-directed therapy. Data on PICU stays were abstracted retrospectively from the medical record. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic and critical illness variables were abstracted from institutional databases and medical records. Neurocognitive and psychosocial outcomes were prospectively obtained at the end of treatment. Children who had a PICU admission experienced significantly lower functioning compared to normative samples in several areas of cognitive functioning (working memory, processing speed, executive functions, inattention, math achievement, fine motor dexterity, and speed), daily living skills, and internalizing problems (all ps < 0.05). Compared with those without PICU admissions, patients with PICU admissions had worse performance on a measure of sustained attention (p = 0.017). The frequency of patients at risk for problems with learning and memory was significantly higher in the PICU group compared with the non-PICU group (25% vs 12%, p = 0.006). Critical illness symptom severity was not associated with neurocognitive or psychological outcomes. CONCLUSIONS Children with ALL, with or without a PICU admission, experienced lower cognitive and psychological outcomes following treatment. Future research is needed to continue identifying risk factors for post-intensive care syndrome (PICS-p) and post-PICU cognitive and psychological impairments in pediatric patients.
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Affiliation(s)
- Kristin Canavera
- Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA
| | - Saad Ghafoor
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Kimberly Fan
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew Elliott
- Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, TN
| | - R Ray Morrison
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
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Riggs BJ, Carpenter JL. Pediatric Neurocritical Care: Maximizing Neurodevelopmental Outcomes Through Specialty Care. Pediatr Neurol 2023; 149:187-198. [PMID: 37748977 DOI: 10.1016/j.pediatrneurol.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023]
Abstract
The field of pediatric neurocritical care (PNCC) has expanded and evolved over the last three decades. As mortality from pediatric critical care illness has declined, morbidity from neurodevelopmental disorders has expanded. PNCC clinicians have adopted a multidisciplinary approach to rapidly identify neurological injury, implement neuroprotective therapies, minimize secondary neurological insults, and establish transitions of care, all with the goal of improving neurocognitive outcomes for their patients. Although there are many aspects of PNCC and adult neurocritical care (NCC) medicine that are similar, elemental difference between adult and pediatric medicine has contributed to a divergent evolution of the respective fields. The low incidence of pediatric critical care illness, the heterogeneity of neurological insults, and the limited availability of resources all shape the need for a PNCC clinical care model that is distinct from the established paradigm adopted by the adult neurocritical care community at large. Considerations of neurodevelopment are fundamental in pediatrics. When neurological injury occurs in a child, the neurodevelopmental stage at the time of insult alters the impact of the neurological disease. Developmental variables contribute to a range of outcomes for seemingly similar injuries. Despite the relative infancy of the field of PNCC, early reports have shown that implementation of a specialized PNCC service elevates the quality and safety of care, promotes education and communication, and improves outcomes for children with acute neurological injuries. The multidisciplinary approach of PNCC clinicians and researchers also promotes a culture that emphasizes the importance of quality improvement and education initiatives, as well as development of and adherence to evidence-based guidelines and family-focused care models.
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Affiliation(s)
- Becky J Riggs
- Division of Pediatric Critical Care Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Jessica L Carpenter
- Division of Pediatric Neurology, University of Maryland Medical Center, Baltimore, Maryland
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7
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Williams CN, Hall TA, Baker VA, Chertow DJ, Vanderlind WM, Bosworth CC, Hartman ME. Follow-up after PICU discharge for patients with acquired brain injury: the role of an abbreviated neuropsychological evaluation and a return-to-school program. Pediatr Crit Care Med 2023; 24:807-817. [PMID: 38156082 PMCID: PMC10752613 DOI: 10.1097/pcc.0000000000003303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Objective To present the results of an abbreviated testing protocol used to screen for neurocognitive and psychological sequelae of critical illness among pediatric intensive care unit (PICU) survivors with acquired brain injury in our post-discharge follow-up programs, and describe our process for facilitating this population's return to academic life. Design Retrospective cohort study. Setting Neurocritical care follow-up programs at two U.S. academic, tertiary medical/surgical PICUs. Patients Children age > 4 years enrolled in the neurocritical care follow-up programs (n=289) at these institutions who underwent neurocognitive and psychological testing between 2017-2021. Interventions None. Measurements and Main Results One month after discharge from the hospital, nearly half of the children and/or their parents (48%) in our neurocritical care follow-up programs identified some type of emotional or behavioral concern compared to their premorbid state, and 15% reported some type of cognitive concern. On evaluation, 35% of the children were given a new neurocognitive diagnosis. Neurocognitive domains regulated by the executive functioning system were the most commonly affected, including attention (54%), memory (31%) and processing speed (27%). One-quarter of the children were given a new psychological diagnosis, most commonly post-traumatic stress disorder (PTSD) or stress-related symptoms (12%). Over 80% of patients in the programs were given new recommendations for school, for both new academic services and new classroom accommodations. Over half of children (57%) were referred for comprehensive follow-up neuropsychological evaluation. Conclusions Abbreviated neurocognitive and psychological evaluation successfully identifies the same deficits commonly found among PICU survivors who undergo longer, more complete testing protocols. When combined with services aimed at successfully re-integrating PICU survivors back to school, this focused evaluation can provide an effective and efficient means of screening for cognitive and emotional deficits among PICU survivors, and establish a rationale for early academic support upon the child's return to school.
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Affiliation(s)
- Cydni N. Williams
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Oregon Health & Science University, Portland, OR
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR
| | - Trevor A. Hall
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, OR
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR
| | - Victoria A. Baker
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
| | - Daniel J. Chertow
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
| | - W. Michael Vanderlind
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, OR
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR
| | | | - Mary E. Hartman
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
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8
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Corti C, Oldrati V, Papini M, Strazzer S, Poggi G, Romaniello R, Borgatti R, Urgesi C, Bardoni A. Randomized clinical trial on the effects of a computerized cognitive training for pediatric patients with acquired brain injury or congenital malformation. Sci Rep 2023; 13:14559. [PMID: 37666983 PMCID: PMC10477344 DOI: 10.1038/s41598-023-41810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
Both acquired injuries and congenital malformations often cause lifelong disabilities in children, with a significant impact on cognitive abilities. Remote computerized cognitive training (CCT) may be delivered in ecological settings to favour rehabilitation continuity. This randomized clinical trial (RCT) evaluated the efficacy of an 8-week multi-domain, home-based CCT in a sample of patients aged 11-16 years with non-progressive acquired brain injury (ABI), brain tumor (BT) and congenital brain malformation (CBM). Following a stepped-wedge research design, patients were randomized into two groups: Training-first group, which started the CCT immediately after baseline assessment and Waiting-first group, which started the CCT after a period of time comparable to that required by the training (8 weeks). Post-training and long-term (6 months) changes were assessed. Both groups improved on visual-spatial working memory after the CCT, with benefits maintained after 6 months, while no other changes in cognitive or psychological measures were found. These findings suggest that a multi-domain CCT can generate benefits in visual-spatial working memory, in accordance with data from extant literature reporting that computer games heavily engage visuo-spatial abilities. We speculate that is tapping on the same cognitive ability with a prolonged training that may generate the greatest change after a CCT.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | - Marta Papini
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Geraldina Poggi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Renato Borgatti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
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Sinha A, Rubin S, Jarvis JM. Promoting Functional Recovery in Critically Ill Children. Pediatr Clin North Am 2023; 70:399-413. [PMID: 37121633 PMCID: PMC11113330 DOI: 10.1016/j.pcl.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Over two-thirds of pediatric critical illness survivors will experience functional impairments that persist after discharge, that is, post-intensive care syndrome in pediatrics (PICS-p). Risk factors include child and family characteristics, invasive procedures, and social determinants of health. Approaches to remediate PICS-p include early rehabilitation, minimizing sedation, psychosocial resources for caregivers, delivery of family-centered care, and longitudinal screening for PICS-p. Challenges include feasible and validated approaches to screening, and resources and coordination for multidisciplinary care. Next steps should include resources to identify and address adverse social determinants of health and examination of treatment efficacy and implementation equity.
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Affiliation(s)
- Amit Sinha
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA
| | - Sarah Rubin
- Department of Critical Care Medicine, University of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA 15224, USA
| | - Jessica M Jarvis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA.
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10
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de Sonnaville ESV, van Woensel JBM, van Goudoever JB, Otten MH, Teela L, Aarnoudse-Moens CSH, Terheggen-Lagro SWJ, van der Hulst AE, Engelen M, Kӧnigs M, Oosterlaan J, Knoester H. Structured Multidisciplinary Follow-Up After Pediatric Intensive Care: A Model for Continuous Data-Driven Health Care Innovation. Pediatr Crit Care Med 2023; 24:484-498. [PMID: 36807306 PMCID: PMC10226472 DOI: 10.1097/pcc.0000000000003213] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Morbidity after PICU admission for critical illness is a growing concern. Sequelae may occur in various domains of functioning and can only appropriately be determined through structured follow-up. Here, we describe the process of designing and implementing a structured multidisciplinary follow-up program for patients and their parents after PICU admission and show the first results illustrating the significance of our program. DESIGN Prospective observational cohort study. SETTING Outpatient PICU follow-up clinic. PATIENTS Patients 0-18 years old admitted to our PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In our structured multidisciplinary follow-up program, follow-up care is provided by a pediatric intensivist and psychologist and in addition, depending on patient's critical illness and received PICU treatment(s), by a pediatric pulmonologist, cardiologist, neurologist, and/or neuropsychologist. All consultations are scheduled consecutively. Collected data are stored in a hospital-wide data warehouse and used for yearly health care evaluation sessions as well as scientific research. Challenges in organizing this follow-up program include technological challenges, providing time-efficient care, participation rate, and completeness of questionnaires. In our experience, a dedicated team is essential to tackle these challenges. Our first results, obtained in 307 of 388 referred patients (79.1%), showed the diversity of problems arising after PICU discharge, including physical, neurocognitive, and psychosocial sequelae. In addition, our data also reflected the risk of psychosocial problems among parents. Within the limited operation time of our follow-up program, the program has evolved based on our experiences and the data collected. CONCLUSIONS We successfully developed and implemented a structured multidisciplinary follow-up program for patients and their parents after PICU admission. This program may help to timely initiate appropriate interventions, improve the standard of care during and after PICU admission, and facilitate scientific research on outcome and prognosis after PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam & Vrije Universiteit, Emma Children's Hospital, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marieke H Otten
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lorynn Teela
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Pulmonology and Allergy, Amsterdam Reproduction and Development & Infection and Immunity Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Annelies E van der Hulst
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marc Engelen
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam Neuroscience & Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marsh Kӧnigs
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hennie Knoester
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Cassidy L, Quirke MB, Alexander D, Greene J, Hill K, Connolly M, Brenner M. Integrated care for children living with complex care needs: an evolutionary concept analysis. Eur J Pediatr 2023; 182:1517-1532. [PMID: 36780041 PMCID: PMC9924191 DOI: 10.1007/s00431-023-04851-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
Children with complex care needs (CCNs) are in need of improved access to healthcare services, communication, and support from healthcare professionals to ensure high-quality care is delivered to meet their needs. Integrated care is viewed as a key component of care delivery for children with CCNs, as it promotes the integration of healthcare systems to provide family and child-centred care across the entire health spectrum. There are many definitions and frameworks that support integrated care, but there is a lack of conceptual clarity around the term. Furthermore, it is often unclear how integrated care can be delivered to children with CCNs, therefore reinforcing the need for further clarification on how to define integrated care. An evolutionary concept analysis was conducted to clarify how integrated care for children with CCNs is defined within current literature. We found that integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies. Conclusion: Given the variation in terms of study design, outcomes, and patient populations this paper highlights the need for further research into methods to measure integrated care. What is Known: • Children with complex care needs require long-term care, and are in need of improved services, communication, and information from healthcare professionals to provide them with the ongoing support they need to manage their condition. • Integrated care is a key component in healthcare delivery for children with complex care needs as it has the potential to improve access to family-centred care across the entire health spectrum. What is New: • Integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies. • There is a need for the development of measurement tools to effectively assess integrated care within practice.
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Affiliation(s)
- Lorna Cassidy
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Mary Brigid Quirke
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Denise Alexander
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Jo Greene
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Katie Hill
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Maria Brenner
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
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12
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Jarvis JM, Huntington T, Perry G, Zickmund S, Yang S, Galyean P, Pinto N, Watson RS, Olson LM, Fink EL, Maddux AB. Supporting families during pediatric critical illness: Opportunities identified in a multicenter, qualitative study. J Child Health Care 2023:13674935231154829. [PMID: 36749657 PMCID: PMC10404638 DOI: 10.1177/13674935231154829] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Critical illness resulting in a pediatric intensive care unit (PICU) admission is a profoundly stressful experience for a child and their family. Increasing evidence for emotional and behavioral sequelae post-PICU emphasizes a need to provide better support for families throughout this period of care and recovery. The aim of this qualitative investigation was to identify salient and modifiable aspects of a critical care experience that can be addressed to better support families of critically ill children. Individual semi-structured interviews were conducted with 26 caregivers of children who survived a PICU admission. Interviews were audio-recorded and transcribed verbatim; themes were identified via thematic analysis. Caregivers were enrolled using convenience sampling from seven tertiary care PICUs in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Themes from caregiver interviews were identified within two overarching categories containing three themes each. Advice for future PICU families: (1) Be intentional about caring for your own well-being, (2) speak up, ask questions, and challenge decisions you're not comfortable with, and (3) continue to engage with your child. Characteristics of a satisfactory PICU experience: (1) A caregiver-provider relationship of mutual trust established through clear communication and respectful collaboration, (2) hospital environments that provide physical and social supports to maintain humanity in healthcare, and (3) preparing families for care transitions. Targeted, interdisciplinary approaches to partner with families during critical care may improve their PICU experience and contribute to improved long-term outcomes for PICU survivors.
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Affiliation(s)
- Jessica M Jarvis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Taylor Huntington
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Grace Perry
- Department of Pediatrics, Pediatric Hospital Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Susan Zickmund
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Serena Yang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Patrick Galyean
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Neethi Pinto
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - R. Scott Watson
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA and Center for Child Health, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Lenora M Olson
- Department of Pediatrics, Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aline B Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
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13
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Larson KR, Demers LA, Holding EZ, Williams CN, Hall TA. Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric Neurocritical Care Population. Neurotrauma Rep 2023; 4:97-106. [PMID: 36895819 PMCID: PMC9989517 DOI: 10.1089/neur.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Youth admitted to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI) commonly struggle with long-term residual effects in the domains of physical, cognitive, emotional, and psychosocial/family functioning. In the cognitive domain, executive functioning (EF) deficits are often observed. The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a parent/caregiver-completed measure that is regularly utilized to assess caregivers' perspectives of daily EF abilities. Using parent/caregiver-completed measures like the BRIEF-2 in isolation as outcome measures for capturing symptom presence and severity might be problematic given that caregiver ratings are vulnerable to influence from external factors. As such, this study aimed to investigate the association between the BRIEF-2 and performance-based measures of EF in youth during the acute recovery period post-PICU admission for TBI. A secondary aim was to explore associations among potential confounding factors, including family-level distress, injury severity, and the impact of pre-existing neurodevelopmental conditions. Participants included 65 youths, 8-19 years of age, admitted to the PICU for TBI, who survived hospital discharge and were referred for follow-up care. Non-significant correlations were found between BRIEF-2 outcomes and performance-based measures of EF. Measures of injury severity were strongly correlated with scores from performance-based EF measures, but not BRIEF-2. Parent/caregiver-reported measures of their own health-related quality of life were related to caregiver responses on the BRIEF-2. Results demonstrate the differences captured by performance-based versus caregiver-report measures of EF, and also highlight the importance of considering other morbidities related to PICU admission.
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Affiliation(s)
- Kera R Larson
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Lauren A Demers
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Z Holding
- Developmental Medical Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Trevor A Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
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14
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Social Functioning and Autistic Behaviors in Youth Following Acquired Brain Injury. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111648. [PMID: 36360376 PMCID: PMC9688193 DOI: 10.3390/children9111648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 01/25/2023]
Abstract
Children and adolescents who survive the pediatric intensive care unit (PICU) with an acquired brain injury (ABI) often demonstrate a variety of physical, cognitive, emotional/behavioral, and social sequelae termed post-intensive care syndrome (PICS). Social communication and interaction challenges have also been observed clinically, and there is growing literature documenting these occurrences in youth following ABI. The extent of these social changes varies among patients, and a subset of patients go on to exhibit social and behavioral profiles closely resembling those of autistic youth. We reviewed empirical research regarding social functioning in youth following ABI, as well as the overlap between individuals with ABI and autistic youth, published from January 2009 to August 2022 on PubMed and Scopus databases. Clinical case examples from a well-established post-PICU follow-up program are also provided to exemplify the complexity of this phenomenon.
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15
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Klapp JM, Hall TA, Riley AR, Williams CN. Sleep disturbances in infants and young children following an acquired brain injury. J Clin Sleep Med 2022; 18:2387-2395. [PMID: 35801337 PMCID: PMC9516583 DOI: 10.5664/jcsm.10116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep disturbances impact over half of older children and teens with acquired brain injury (ABI) following critical care hospitalization but are underevaluated in infants and young children. Given the importance of sleep in brain development and healing after injury, we hypothesized sleep disturbances would be associated with worse neurodevelopmental outcomes in infants with ABI. METHODS We performed a retrospective cohort study of 68 children aged 2-32 months following critical care hospitalization for ABI. The Brief Infant Sleep Questionnaire assessed sleep disturbances. Bayley Scales of Infant and Toddler Development, third edition and Adaptive Behavior Assessment System, third edition assessed developmental and adaptive functioning outcomes, respectively. t tests compared sleep characteristics in infants with ABI to historical healthy controls. Spearman's correlation evaluated relationships among sleep and outcomes. Multiple linear regression investigated relationships controlling for demographic and ABI characteristics. RESULTS Compared to healthy controls, children with ABI had shorter nighttime sleep duration (P = .01), longer daytime sleep duration (P < .001), and longer duration of nighttime awakenings (P < .001). Duration of night awakenings negatively correlated with Bayley Cognitive scores (Spearman's correlation = -.40). Night awakenings negatively correlated with worse Adaptive Behavior Assessment System, third edition General Adaptive Composite scores (Spearman's correlation = -.42). When controlling for demographic and ABI characteristics, ≥ 3 awakenings was significantly associated with worse Adaptive Behavior Assessment System, third edition General Adaptive Composite (β = -11.3; 95% confidence interval = -19.2, -3.5). CONCLUSIONS Sleep disturbances are associated with poorer outcomes in infants and toddlers after ABI. Sleep is vital to recovery and a potentially modifiable target to improve outcomes. CITATION Klapp JM, Hall TA, Riley AR, Williams CN. Sleep disturbances in infants and young children following an acquired brain injury. J Clin Sleep Med. 2022;18(10):2387-2395.
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Affiliation(s)
- Jamie M. Klapp
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Andrew R. Riley
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health & Science University, Portland, Oregon
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health & Science University, Portland, Oregon
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16
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Malone LA, Morrow A, Chen Y, Curtis D, de Ferranti SD, Desai M, Fleming TK, Giglia TM, Hall TA, Henning E, Jadhav S, Johnston AM, Kathirithamby DRC, Kokorelis C, Lachenauer C, Li L, Lin HC, Locke T, MacArthur C, Mann M, McGrath-Morrow SA, Ng R, Ohlms L, Risen S, Sadreameli SC, Sampsel S, Tejtel SKS, Silver JK, Simoneau T, Srouji R, Swami S, Torbey S, Gutierrez MV, Williams CN, Zimmerman LA, Vaz LE. Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of postacute sequelae of SARS-CoV-2 infection (PASC) in children and adolescents. PM R 2022; 14:1241-1269. [PMID: 36169159 PMCID: PMC9538628 DOI: 10.1002/pmrj.12890] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Laura A Malone
- Kennedy Krieger Institute, Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland, United States.,Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Amanda Morrow
- Kennedy Krieger Institute, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Yuxi Chen
- Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, New York, United States
| | - Donna Curtis
- Department of Pediatric Infectious Diseases Children's Hospital Colorado and University of Colorado School of Medicine Aurora, Aurora, Colorado, United States
| | - Sarah D de Ferranti
- Department of Pediatrics, Harvard Medical School, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Monika Desai
- Department of Rehabilitation Medicine, Montefiore Medical Center/Albert Einstein School of Medicine, Bronx, New York, United States
| | - Talya K Fleming
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey, United States
| | - Therese M Giglia
- Director of the Center on Cardiac Anticoagulation and Thrombosis and Director of the Infant Single Ventricle Monitoring Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Trevor A Hall
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Ellen Henning
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Sneha Jadhav
- Psychiatric Mental Health Program, Kennedy Krieger Institute, Baltimore, Maryland, United States
| | - Alicia M Johnston
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Dona Rani C Kathirithamby
- Department of Rehabilitation Medicine and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States
| | - Christina Kokorelis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University and Kennedy Krieger Institute, Baltimore, Maryland, United States
| | - Catherine Lachenauer
- Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Lilun Li
- Department of Otolaryngology, Head and Neck Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Henry C Lin
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery Baylor College of Medicine Houston, Houston, Texas, United States
| | - Carol MacArthur
- Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Science University, Oregon, Portland
| | - Michelle Mann
- Department of Pediatric Pulmonology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States
| | - Sharon A McGrath-Morrow
- Department of Pediatrics, Division of Pediatric Pulmonary Children's Hospital of Philadelphia and the University of Pennsylvania
| | - Rowena Ng
- Neuropsychology Department, Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Laurie Ohlms
- Department of Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sarah Risen
- Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, United States
| | - S Christy Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sarah Sampsel
- SLSampsel Consulting, Albuquerque, New Mexico, United States
| | - S Kristen Sexson Tejtel
- Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Rasha Srouji
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Sanjeev Swami
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Souraya Torbey
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Monica Verduzco Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine at UT Health Science Center San Antonio, San Antonio, Texas, United States
| | - Cydni Nicole Williams
- Oregon Health & Science University, Department of Pediatrics, Division of Pediatric Critical Care, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon, United States
| | | | - Louise Elaine Vaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
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17
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Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury. CHILDREN 2022; 9:children9091321. [PMID: 36138630 PMCID: PMC9497748 DOI: 10.3390/children9091321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.
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18
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Hall TA, Greene RK, Lee JB, Leonard S, Bradbury KR, Drury K, Recht G, Randall J, Norr ME, Williams CN. Post-Intensive Care Syndrome in a Cohort of School-Aged Children and Adolescent ICU Survivors: The Importance of Follow-up in the Acute Recovery Phase. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1747935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractPediatric intensive care unit (PICU) survivors experience a collection of physical, cognitive, emotional, and social symptoms named post-intensive care syndrome (PICS). We aimed to quantify PICS morbidities from multiple stakeholder perspectives across domains. Using physician, neuropsychologist, and parent/caregiver-completed outcome measures across domains in a cross-sectional analysis of 186 children between the ages of 8 and 19 years with data from a PICU follow-up clinic 1 to 3 months after PICU discharge, we quantified PICS morbidities and used Spearman correlation to evaluate interdependence of PICS domains. Compared with pre-hospitalization functioning, new PICS-related morbidities were observed and significant correlations were identified between the PICS domains. Results highlight the need to identify and support patients and families for multiple morbidities simultaneously across all relevant PICS domains; moreover, an important divergence between caregiver report, physician, and neuropsychologist assessment was also found, showcasing the importance of multiple assessments and perspectives. New PICS morbidities across domains are common after discharge from the PICU, and timely follow-up care is needed that involves collaboration/integration of physicians, neuropsychologists, youth, and families to effectively identify and treat PICS-related issues.
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Affiliation(s)
- Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Rachel K. Greene
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Justin B. Lee
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Skyler Leonard
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Kathryn R. Bradbury
- Children's Neuropsychological Services, Andover, Massachusetts, United States
| | - Kurt Drury
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
- Division of Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Grace Recht
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Julie Randall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Megan E. Norr
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
- Division of Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
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19
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Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050748. [PMID: 35626925 PMCID: PMC9139390 DOI: 10.3390/children9050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3−18 years with TBI 1−3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes.
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20
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The Association Between Functional Status and Health-Related Quality of Life Following Discharge from the Pediatric Intensive Care Unit. Neurocrit Care 2021; 35:347-357. [PMID: 34272680 PMCID: PMC9126134 DOI: 10.1007/s12028-021-01271-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite one third of children with acquired brain injury (ABI) experiencing new functional impairments following critical care admission, there is limited research investigating the impact of new functional impairments on overall health-related quality of life (HRQOL) or among important HRQOL domains. We aimed to investigate the association between new functional impairments, measured by the Functional Status Scale (FSS), and HRQOL in pediatric patients with ABI after critical care. METHODS We conducted a secondary analysis of a prospective observational study of 275 children aged 2 months to 18 years with ABI. The primary exposure evaluated was change in FSS from baseline at hospital discharge, categorized per prior work (no change, 1-2 point increase, and ≥ 3 point increase). The primary outcome was overall HRQOL 6 months after hospital discharge, measured by the Pediatric Quality of Life Inventory (PedsQL) total score. Secondary outcomes were PedsQL domain scores. PedsQL total and domain scores were transformed into age-standardized z scores for analyses. Multiple linear regression models evaluated the association between FSS change category and HRQOL (overall and domain z scores) when controlling for demographic and clinical characteristics and were reported as β-coefficients with 95% confidence intervals. RESULTS Complete data were analyzed for 195 (71%) children, including 127 with traumatic brain injury. New functional impairment was common with 32 (16%) patients experiencing FSS increases ≥ 3, 50 (26%) patients with FSS increases of 1-2 points, and 113 (58%) patients with no change from prehospital baseline. The majority of children (63%) demonstrated HRQOL ratings ≥ 1 standard deviation below healthy age-based standards (z scores ≤ - 1). Regression models demonstrated older age, female sex, presence of comorbidities, and preadmission cardiopulmonary resuscitation were all significantly associated with poorer overall HRQOL (all p < 0.05). FSS increase ≥ 3 at discharge was significantly associated with worse overall HRQOL at follow-up (β = - 1.07; 95% confidence interval = - 1.63 to - 0.52) when controlling for the aforementioned significant factors, and significantly improved model fit (p value for change = 0.001). Similar findings in secondary analyses were found for physical domain scores, with FSS increase showing a significant association with worse physical HRQOL scores and improvements in model fit. Change in FSS was not significantly associated with other HRQOL domain scores (emotional, social, school, psychosocial). CONCLUSIONS Many children with ABI after critical care experience new functional impairments (FSS increases) and worse HRQOL than healthy peers. FSS increase at discharge is a significant risk factor for worse HRQOL in the months after hospital discharge and improves HRQOL models beyond illness and demographic variables alone.
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21
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Riley AR, Williams CN, Moyer D, Bradbury K, Leonard S, Turner E, Holding E, Hall TA. Parental Posttraumatic Stress Symptoms in the Context of Pediatric Post Intensive Care Syndrome: Impact on the Family and Opportunities for Intervention. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2021; 9:156-166. [PMID: 34458053 DOI: 10.1037/cpp0000399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective Pediatric intensive care unit (PICU) survivors and their families experience ongoing impacts on physical, cognitive, and psychosocial functioning, described as Post-Intensive Care Syndrome (PICS). The objective of this study was to determine whether the posttraumatic stress symptoms (PTSS) of parents predict the impact of critical illness on families following PICU admission beyond other factors (e.g., sex, race/ethnicity, age, insurance status, illness severity, family involvement or death). Method We conducted a retrospective analysis of data from 88 children aged 1 month to 18 years who were hospitalized with critical illness and acquired brain injury in the PICU and their families. Patients and their families participated in a 1-3 month post-discharge follow-up assessment, during which data on demographics, medical diagnoses, parent self-report of PTSS, and family impact of critical illness (via the Pediatric Quality of Life Family Impact Module) were collected. We used a hierarchical linear regression to determine whether parent PTSS predicted family impact above and beyond demographic and injury/illness factors. Results One-third of parents reported elevated PTSS. Among those with complete available data (n = 56), PTSS were the only significant predictor of family impact (β = -.52, t = -3.58, p = .001), with the overall model accounting for 41% of variance. Conclusion In addition to the direct effects on parents of children who survive the PICU, PTSS may negatively impact families and interfere with rehabilitative progress. We provide a rationale and conceptual model for integrating interventions designed to address parent PTSS into post-PICU care.
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Affiliation(s)
- Andrew R Riley
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher children's Hospital, Portland, Oregon
| | - Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, Oregon.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University and Doernbecher Children's Hospital, Portland, Oregon
| | - Danielle Moyer
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher children's Hospital, Portland, Oregon
| | - Kathryn Bradbury
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher children's Hospital, Portland, Oregon
| | - Skyler Leonard
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher children's Hospital, Portland, Oregon
| | - Elise Turner
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher children's Hospital, Portland, Oregon
| | - Emily Holding
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher children's Hospital, Portland, Oregon
| | - Trevor A Hall
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher children's Hospital, Portland, Oregon.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University and Doernbecher Children's Hospital, Portland, Oregon
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22
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Bradbury KR, Williams C, Leonard S, Holding E, Turner E, Wagner AE, Piantino J, Luther M, Hall TA. Emotional Aspects of Pediatric Post-Intensive Care Syndrome Following Traumatic Brain Injury. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:177-187. [PMID: 33986904 PMCID: PMC8099982 DOI: 10.1007/s40653-020-00332-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 05/05/2023]
Abstract
Children with traumatic brain injury (TBI) requiring neurocritical care are at risk for neurocognitive, emotional, physical, and psychosocial difficulties, collectively known as Post-Intensive Care Syndrome. Our study assessed parent-reported emotional functioning and identified risk factors for emotional sequelae in the acute recovery phase. Fifty-three children between 5 and 18 years old hospitalized for TBI were assessed 1-month following discharge. Relevant injury-, child-, and family-specific variables were collected. Emotional functioning was assessed using PROMIS Parent Proxy Report Short Forms for Anxiety and Depressive Symptoms. We used Chi-square tests to evaluate differences between children with and without elevations in anxiety and depressive symptoms. Logistic regression determined predictors of elevations in symptoms among significant variables. Parents frequently endorsed moderate or worse anxiety (45.2%) and depressive (32.1%) symptoms among children. Mechanism of injury and elevated parent post-traumatic stress disorder (PTSD) symptoms were associated with elevated anxiety and depressive symptoms, while direct family involvement in the accident/injury was associated only with elevated anxiety symptoms. Results from logistic regression indicated that only elevated parent PTSD symptoms were a significant predictor for child anxiety and depressive symptoms. Anxiety and depressive symptoms are prevalent in the acute recovery phase of TBI. Consistent with previous research, elevations in anxiety and depressive symptoms were more related to psychosocial factors than injury severity. High levels of parent PTSD symptoms and their relationship with children's internalizing symptoms highlight the need for mental health treatment for TBI patients and their families.
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Affiliation(s)
- Kathryn R. Bradbury
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
- Children’s Neuropsychological Services, 26 Chestnut Street, Suite 2E, Andover, MA USA
| | - Cydni Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, OR USA
| | - Skyler Leonard
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
| | - Emily Holding
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
| | - Elise Turner
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
| | - Amanda E. Wagner
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
- Child Mind Institute, San Mateo, CA USA
| | - Juan Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, OR USA
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
| | - Madison Luther
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, OR USA
| | - Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children’s Hospital, Portland, OR USA
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, OR USA
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23
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6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital: a retrospective cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:473-482. [PMID: 34043958 DOI: 10.1016/s2352-4642(21)00138-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a new, rare, post-infectious complication of SARS-CoV-2 infection in children. We aimed to describe the 6-month outcomes of PIMS-TS. METHODS This retrospective cohort study comprised children (aged <18 years) who fulfilled the UK Royal College of Paediatrics and Child Health (RCPCH) diagnostic criteria for PIMS-TS and were admitted to Great Ormond Street Hospital (London, UK) between April 4 and Sept 1, 2020. Patients were followed up by a multidisciplinary team of specialists at 6 weeks and 6 months after admission. Biochemical and functional outcomes were analysed. FINDINGS 46 children were included in this study. The median age at presentation was 10·2 years (IQR 8·8-13·3), 30 (65%) patients were male and 16 (35%) were female, 37 (80%) were from minority ethnic groups, and eight (17%) had pre-existing comorbidities. All patients had elevated markers of systemic inflammation at baseline. None of the patients died. By 6 months, systemic inflammation was resolved in all but one patient. 38 (90%) of 42 patients who had positive SARS-CoV-2 IgG antibodies within 6 weeks of admission remained seropositive at 6 months. Echocardiograms were normal in 44 (96%) of 46 patients by 6 months, and gastrointestinal symptoms that were reported in 45 (98%) of 46 patients at onset were present in six (13%) of 46 patients at 6 months. Renal, haematological, and otolaryngological findings largely resolved by 6 months. Although minor abnormalities were identified on neurological examination in 24 (52%) of 46 patients at 6 weeks and in 18 (39%) of 46 at 6 months, we found minimal functional impairment at 6 months (median Expanded Disability Status Scale score 0 [IQR 0-1]). Median manual muscle test-8 scores improved from 53 (IQR 43-64) during hospital admission to 80 (IQR 68-80) at 6 months, but 18 (45%) of 40 patients showed 6-min walk test results below the third centile for their age or sex at 6 months. PedsQL responses revealed severe emotional difficulties at 6 months (seven [18%] of 38 by parental report and eight [22%] of 38 by self report). 45 (98%) of 46 patients were back in full-time education (virtually or face to face) by 6 months. INTERPRETATION Despite initial severe illness, few organ-specific sequelae were observed at 6 months. Ongoing concerns requiring physical re-conditioning and mental health support remained, and physiotherapy assessments revealed persisting poor exercise tolerance. Longer-term follow-up will help define the extended natural history of PIMS-TS. FUNDING None.
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