Pinto Neethi P, Rhinesmith Elizabeth W, Kim Tae Yeon, Ladner Peter H, Pollack Murray M
1Department of Pediatrics, The University of Chicago, Chicago, IL. 2Department of Pediatrics, Children's National Medical Center, Washington, DC. 3Pritzker School of Medicine, The University of Chicago, Chicago, IL.
Pediatr Crit Care Med. 2017 Mar;18(3):e122-e130. doi: 10.1097/PCC.0000000000001070.
Knowledge of the long-term outcomes of survivors of pediatric critical illness is sparse but important. The aim of this study was to evaluate morbidity and mortality 6 months and 3 years after hospital discharge.
Prospective cohort study.
Urban, inner city, academic PICU.
Consecutive patients admitted to the PICU from June 2012 to August 2012.
None.
We collected descriptive and demographic information and functional status assessments at baseline, admission, hospital discharge, 6 months and 3 years following discharge. Functional status was measured with the Functional Status Scale. New morbidity was defined as a change in Functional Status Scale score of greater than or equal to 3. Postdischarge assessments utilized scripted telephone surveys. Of 303 consecutive PICU patients, 253 were eligible and 129 parents consented. Follow-up outcomes were obtained for 77 patients (59.7%) at 6 months and 70 of these patients (54.2%) at 3 years. Both mortality and morbidity increased after discharge. Cumulative mortality increased from 3.9% (n = 3) at discharge to 7.8% (n = 6) at 6 months (p = 0.08) and 10.4% (n = 8) at 3 years (p = 0.03). New morbidity increased cumulatively from 5.2% (n = 4) at discharge to 6.5% (n = 5) at 6 months (p = 0.65) and 10.4% (n = 8) at 3 years (p = 0.16). Almost as many children demonstrated worsening of their functional status or died (38%) as children who survived without a change in functional status (44%). Less than 10% of children exhibited functional gains over time. Long-term functional outcome was associated with PICU variables including the need for invasive therapies and indicators of severity of illness such as use of mechanical ventilation, ventilator days, use of vasoactive medications, and PICU length of stay. The combined poor outcomes of new morbidity and mortality increased cumulatively from 9.1% (n = 7) at discharge to 14.3% (n = 11) at 6 months (p = 0.16) and 20.8% (n = 16) by 3 years (p = 0.01).
Mortality and new morbidity appear to substantially increase after discharge. Critical illness is associated with a sustained impact on survival and functional status.
关于儿科危重症幸存者的长期预后的了解较为匮乏，但却很重要。本研究的目的是评估出院后6个月和3年的发病率和死亡率。
前瞻性队列研究。
城市中心的学术性儿科重症监护病房。
2012年6月至2012年8月连续入住儿科重症监护病房的患者。
无。
我们在基线、入院、出院、出院后6个月和3年收集了描述性和人口统计学信息以及功能状态评估。功能状态采用功能状态量表进行测量。新发病定义为功能状态量表评分变化大于或等于3分。出院后的评估采用脚本化电话调查。在303例连续入住儿科重症监护病房的患者中，253例符合条件，129例家长同意参与。77例患者（59.7%）在6个月时获得随访结果，其中70例患者（54.2%）在3年时获得随访结果。出院后死亡率和发病率均有所增加。累积死亡率从出院时的3.9%（n = 3）增至6个月时的7.8%（n = 6）（p = 0.08），3年时为10.4%（n = 8）（p = 0.03）。新发病例累积发生率从出院时的5.2%（n = 4）增至6个月时的6.5%（n = 5）（p = 0.65），3年时为10.4%（n = 8）（p = 0.16）。功能状态恶化或死亡的儿童比例（38%）与功能状态无变化而存活的儿童比例（44%）几乎相同。随着时间推移，不到10%的儿童功能有所改善。长期功能预后与儿科重症监护病房的变量相关，包括侵入性治疗的需求以及疾病严重程度指标，如机械通气的使用、通气天数、血管活性药物的使用和儿科重症监护病房住院时间。新发病例和死亡的综合不良预后累积发生率从出院时的9.1%（n = 7）增至6个月时的14.3%（n = 11）（p = 0.16），3年时为20.8%（n = 16）（p = 0.01）。
出院后死亡率和新发病例似乎大幅增加。危重症对生存和功能状态有持续影响。
