Post-intensive Care Syndrome in a Heterogeneous Pediatric Population

Muthiah R Annamalai; Joshua T Kuehne; Kiran Mainali; Utpal Bhalala

doi:10.7759/cureus.32928

Post-intensive Care Syndrome in a Heterogeneous Pediatric Population

Cureus. 2022 Dec 25;14(12):e32928. doi: 10.7759/cureus.32928. eCollection 2022 Dec.

Authors

Muthiah R Annamalai¹, Joshua T Kuehne², Kiran Mainali³, Utpal Bhalala^{4

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Affiliations

¹ Pediatrics, University of Tennessee Health Science Center, Memphis, USA.
² Medical School, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA.
³ Epidemiology and Biostatistics, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA.
⁴ Pediatrics, Texas A&M College of Medicine, College Station, USA.
⁵ Anesthesiology and Critical Care, University of Texas Medical Branch at Galveston, Galveston, USA.
⁶ Anesthesiology and Critical Care, Driscoll Children's Hospital, Corpus Christi, USA.

Abstract

Background In this study, we aimed to measure the incidence of post-intensive care syndrome among children (PICS-p) who received critical care treatment in our hospital and evaluate patient characteristics and critical care interventions associated with the development of PICS-p. Methodology We conducted a retrospective cohort review of all surviving pediatric patients admitted to an urban, academic, tertiary intensive care unit between July 2017 and June 2018. Based on the existing literature on PICS, we excluded children whose length of stay in the pediatric intensive care unit (PICU) was less than four days. We collected demographic data, clinical data, and data related to outcomes in our study cohort. We defined PICS-p a priori as a change in the Functional Status Scale (FSS) score of three or greater between pre-admission and discharge. Using Student's t-tests and Wilcoxon rank-sum tests, we compared outcomes among those with PICS-p versus those without PICS-p. Results Of the 183 patients, 36 (19.6%) were diagnosed with PICS in our study. Aside from pre-admission FSS (7 vs. 8), analysis of the two groups revealed no statistically significant difference before or at the time of admission. Upon admission to the PICU, statistically significant differences between the PICS and no PICS groups were noted in the hospital length of stay (33.5 days vs. 14.7 days), ventilation-free days (8.3 days vs. 5.2 days), and the number of procedural interventions (2.6 vs. 1). Conclusions Utilizing the FSS to determine PICS is a viable method to standardize the measurement of functional outcomes for critically ill children. In our single-center, retrospective review, nearly one out of five pediatric patients developed PICS with associated factors that included a decreased pre-hospital FSS score, increased hospital length of stay, fewer ventilation-free days, and increased number of procedural interventions. Significant opportunities exist regarding the social and psychiatric domains of PICS-p.

Keywords: children; critical care; functional status score (fss); outcomes; pediatric intensive care unit (picu); post-intensive care syndrome (pics).