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Long D, Minogue J, Charles K, Morgan S, Schults J, Le Marsney R, Stocker C, Gibbons KS, Dow B. Neurodevelopmental outcome and quality of life in children admitted to the paediatric intensive care unit: A single-centre Australian cohort study. Aust Crit Care 2024:S1036-7314(24)00087-0. [PMID: 38866692 DOI: 10.1016/j.aucc.2024.05.001] [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: 12/11/2023] [Revised: 04/15/2024] [Accepted: 05/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The development of new morbidities has become increasingly identified in paediatric critical care medicine. To date, there has been limited research of long-term outcomes following paediatric critical illness in Australia. OBJECTIVES The objective of this study was to quantify neurodevelopmental impairments in children following paediatric intensive care unit (PICU) discharge and their association with health-related quality of life (HRQoL). METHODS A single-centre ambidirectional cohort study at an Australian hospital. Parents of children admitted to the PICU between 2015 and 2017 were invited to participate. Neurodevelopmental outcome and HRQoL was prospectively evaluated, using the Ages and Stages Questionnaire (<5 years), Strengths and Difficulties Questionnaire (≥5 years), and Pediatric Quality of Life Inventory™, respectively. RESULTS A total of 230 parents of critically ill children participated. Children were 1.9 years old (median, interquartile range [IQR]: 0.2, 7.5), male (59.6%), and ventilated (49.1%) at PICU admission. The median time to follow-up was 24.4 months (IQR: 16.3, 36.7). Parent respondents were more likely to be female (85.5%), White (88.3%), and partnered (81.1%). The incidence of overall neurodevelopmental impairment was 30% (33% in children aged <5 years; 24% in children aged ≥5 years). The incidence of poor HRQoL was 37.9%. History of developmental delay was independently associated with overall neurodevelopmental impairment (adjusted odds ratio [aOR]: 4.21, 95% confidence interval: 2.05, 8.63) and poor HRQoL (aOR: 7.29, 95% confidence interval: 3.26, 16.27). Two or more PICU admissions (aOR: 4.10, IQR: 1.82, 9.26) was also associated with poor HRQoL. CONCLUSIONS This is the first contemporary view of PICU long-term outcomes conducted in Australia and significantly informs ongoing research in this area. Approximately one-third of PICU survivors demonstrate neurodevelopmental impairment and reduced quality of life. Multiple domains of post-intensive care syndrome-paediatrics must be considered to have a comprehensive understanding of child outcomes. Assessment of baseline/premorbid functioning is also essential in order to understand the true impact of illness and PICU admission.
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Affiliation(s)
- Debbie Long
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia.
| | - Jessicah Minogue
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Neonatal Intensive Care Unit, Mater Mother's Hospital, Brisbane, Australia
| | - Karina Charles
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Suzanne Morgan
- Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
| | - Jessica Schults
- Child Health Research Centre, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Renate Le Marsney
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Christian Stocker
- Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
| | - Kristen S Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Belinda Dow
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Komanchuk J, Cameron JL, Kurbatfinski S, Duffett-Leger L, Letourneau N. A realist review of digitally delivered child development assessment and screening tools: Psychometrics and considerations for future use. Early Hum Dev 2023; 183:105818. [PMID: 37413949 DOI: 10.1016/j.earlhumdev.2023.105818] [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: 04/05/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Developmental screening improves the detection of developmental concerns, yet numerous children are not screened/assessed. Remote child developmental tool administration has been utilized to increase screening and assessment accessibility. METHOD We conducted a realist review to: (1) identify existing multi-domain child development assessment and screening tools for children 0-5 years; (2) review psychometric data on their digital (i.e., only administered remotely) administration; and (3) explore contextual factors relevant to their digital administration. We searched APA PsycInfo, MEDLINE, CINAHL, and ERIC to identify tools and papers on their psychometrics. We reference-searched included articles and searched Google for relevant grey literature. RESULTS Of 33 multi-domain child development tools identified in objective one, five tools (in five studies) were delivered digitally and compared to traditional (e.g., paper) delivery (i.e., objective two). Studies evaluated within-group equivalence reliability (k = 2) and between-group equivalence (k = 3). Within-group equivalence reliability was established for the Vineland Adaptive Behavior Scales, and domains (e.g., gross motor) of the Ages and Stages Questionnaires 2nd edition (ASQ-2) and Revised Prescreening Denver Questionnaire (R-PDQ). Between group equivalence was demonstrated for Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-II) subtests and Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3) items. In another between group evaluation, web-based and paper versions of the ASQ-2 were deemed generally equivalent. Digital Bayley-3 inter-observer reliability ranged from 0.82 to 1.0. Examiner support, time, tool modifications, family resources, and comfort promotion supported digital administration. CONCLUSION Digitally delivered ASQ-2, R-PDQ, Vineland, and Bayley-3 and NEPSY-II components show promise for equivalence with traditional administration.
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Affiliation(s)
| | - Judy L Cameron
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Biagas KV, Heneghan JA, Abu-Sultaneh S, Geneslaw AS, Maddux AB, Pinto NP, Murphy SA, Shein SL, Cronin MT. Scoping Review: Neurocognitive Outcome Assessments After Critical Illness in Children. J Intensive Care Med 2023; 38:358-367. [PMID: 36069025 DOI: 10.1177/08850666221121567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To map the literature regarding assessment of neurocognitive outcomes in PICU survivors. Secondary objectives were to identify literature gaps and to provide data for development of a Core Outcome Measures Set in the domain. METHODS Planned, a priori analysis was performed of data from an over-all scoping review of Post-Intensive Care Syndrome-pediatrics (PICS-p) functional outcomes. English-language databases and registries from 1970 to 2017 were searched by a medical librarian to identify manuscripts reporting on Post Intensive Care Syndrome-pediatrics (PICS-p). Further, detailed data extraction for neurocognitive outcomes was performed focusing on study characteristics, instruments used, and populations. RESULTS 114 instruments evaluated neurocognitive function in 183 manuscripts. 83% of manuscripts were published after 2000. Median of 3 (IQR 2-5) neurocognitive instruments per manuscript were reported. Wechsler Scales (45%), clinical neurologic evaluations (21%), Pediatric Cerebral Performance Category (20%), Bayley Scales of Infant Development (16%), and Vineland Adaptive Behavior Scales (11%) were the most commonly used instruments. Median sample size was 65 (IQR 32-129) subjects. Most (63%) assessments were conducted in-person and parents/guardians (40%) provided the information. Patients with congenital heart disease and traumatic brain injury were most commonly evaluated (31% and 24% of manuscripts, respectively). Adolescents were the most commonly studied age group (34%). Baseline function was infrequently assessed (11% of manuscripts); most studies assessed patients at only one time point after PICU discharge. Within studies, neurocognitive assessments were often combined with others - especially social (18%) and physical (8%). CONCLUSIONS 183 manuscripts studied the neurocognitive domain of PICS-p. Studies were quantitative and tended to focus on populations with anticipated cognitive impairment. Considerable variability exists among the chosen 114 instruments used; however, 4 instruments were frequently chosen with focus on intelligence, cerebral functioning, and developmental and adaptive behavior. The literature is marked by lack of agreement on methodologies but reflects the burgeoning interest in studying PICS-p neurocognitive outcomes.
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Affiliation(s)
- Katherine V Biagas
- 12300The Renaissance School of Medicine at Stony Brook University and the Stony Brook Children's Hospital, Stony Brook, USA
| | - Julia A Heneghan
- 65830University of Minnesota Masonic Children's Hospital, Minneapolis, USA
| | - Samer Abu-Sultaneh
- 22536Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, 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
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine.,Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah A Murphy
- Department of Pediatrics, MassGeneral Brigham Hospital, Harvard Medical School, Boston, MA
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