Seattle Children's Hospital, University of Washington, P.O. Box 5371, Seattle, WA, 98105-0371, USA,
Intensive Care Med. 2015 Jul;41(7):1235-46. doi: 10.1007/s00134-015-3780-7. Epub 2015 Apr 8.
The aims of this focused review of the literature on children surviving critical illness were to (1) determine whether health-related quality of life (HRQL) represents a clinically meaningful outcome measure for children surviving critical illness and (2) evaluate the HRQL measures implemented in pediatric critical care studies to date.
This was a focused review of the literature from 1980 to 2015 based on a search of EMBASE/PubMed, MEDLINE and PsycInfo assessing trends and determinants of HRQL outcomes in children surviving critical illness. We also evaluated the psychometric properties of the HRQL instruments used in the studies identified by examining each measure's reported reliability, validity and sensitivity to clinical change.
The literature search identified 253 pediatric articles for potential inclusion in the review, among which data from 78 studies were ultimately selected for inclusion. Of the 22 measures utilized in the studies reviewed, only four demonstrated excellent psychometric properties for use in pediatric critical care trials. Trends in HRQL identified in the studies reviewed suggest significant ongoing morbidity for children surviving critical illness. Key determinants of poor HRQL outcomes include reason for PICU admission (sepsis, meningoencephalitis, trauma), antecedents (chronic comorbid conditions), treatments received (prolonged cardiopulmonary resuscitation, long-stay patients, invasive technology), psychological outcomes (post-traumatic stress disorder, parent anxiety/depression) and social and environmental characteristics (low socioeconomic status, parental education and functioning).
Validated pediatric HRQL instruments are now available. Significant impact on HRQL has been demonstrated in acute and acute on chronic critical illness. Future pediatric critical care interventional trials should include both mortality as well as long-term HRQL measurements to truly ascertain the full impact of critical illness in children.
本项针对儿童危重病存活者的文献综述旨在：(1)确定健康相关生活质量(HRQL)是否代表儿童危重病存活者的一种有临床意义的结果测量方法；(2)评估迄今为止儿科重症监护研究中实施的 HRQL 测量方法。
本研究是对 1980 年至 2015 年文献的重点回顾，检索 EMBASE/PubMed、MEDLINE 和 PsycInfo，评估儿童危重病存活者 HRQL 结果的趋势和决定因素。我们还通过检查每项测量报告的可靠性、有效性和对临床变化的敏感性，评估研究中使用的 HRQL 工具的心理测量特性。
文献检索确定了 253 篇儿科文章，作为本综述的潜在纳入对象，其中最终有 78 项研究的数据被纳入。在综述中评估的 22 项测量工具中，只有 4 项在儿科重症监护试验中表现出良好的心理测量特性。综述中确定的 HRQL 趋势表明，儿童危重病存活者存在持续的发病率。HRQL 结果不良的主要决定因素包括 PICU 入院原因(脓毒症、脑膜炎、创伤)、先存疾病(慢性合并症)、接受的治疗(心肺复苏延长、长期住院患者、有创技术)、心理结局(创伤后应激障碍、父母焦虑/抑郁)和社会及环境特征(社会经济地位低、父母教育和功能)。
现在已经有了经过验证的儿科 HRQL 工具。急性和急性加重慢性危重病对 HRQL 有显著影响。未来的儿科重症监护干预试验应同时包括死亡率和长期 HRQL 测量，以真正确定危重病对儿童的全面影响。
