Mathew Smitha R, Elia Josephine, Penfil Scott, Slamon Nicholas B
Nemours/Alfred I. duPont Hospital for Children, Wilmington, Deleware, USA.
Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Telemed J E Health. 2020 Aug;26(8):1043-1050. doi: 10.1089/tmj.2019.0145. Epub 2019 Oct 30.
Background:Postintensive care syndrome (PICS) is well-defined in the adult literature but has not received much attention in pediatrics.
Introduction:We sought to use a telemedicine platform for the characterization of PICS by creating a convenient and effective virtual follow-up clinic.
Materials and Methods:Prospective single-center study in a pediatric intensive care unit (ICU) of patients aged 4-17 years who underwent any invasive procedures while admitted to the ICU. Parents completed the Weiss Functional Impairment Rating Scale (WFIRS) based on baseline behaviors before ICU admission, with the scale readministered at 1 week, 1 month, and 3 months postdischarge via secure telehealth platform. Patients with a WFIRS baseline raw score of 10 or an interval increase of 2 were referred to psychiatry for evaluation and treatment.
Results:Fifty patients were enrolled. Risk factors for PICS included number of procedural interventions, length of pediatric ICU stay, number of specialty consults, sex, race, and duration of sedation/airway instrumentation. In univariate analysis, age appeared to be the only statistically significant factor associated with the development of PICS. Variables associated with a higher change in WFIRS score showed a statistically significant correlation with the number of procedures completed, the number of specialists involved, and the need for a psychiatric referral. Only 34% of total telemedicine follow-ups were completed.
Discussion:There is an association between age and the development of PICS and between change in WFIRS score and number of procedures, specialist involved, and psychiatric referral.
Conclusions:The use of telemedicine did not result in an improved follow-up rate when compared to outpatient clinic studies.
重症监护后综合征（PICS）在成人文献中有明确界定，但在儿科领域尚未受到太多关注。
我们试图通过创建一个便捷有效的虚拟随访诊所，利用远程医疗平台对PICS进行特征描述。
在一家儿科重症监护病房（ICU）对4至17岁的患者进行前瞻性单中心研究，这些患者在入住ICU期间接受了任何侵入性操作。家长根据患者入住ICU前的基线行为完成韦斯功能损害评定量表（WFIRS），出院后1周、1个月和3个月通过安全的远程医疗平台再次进行该量表评定。WFIRS基线原始分数为10或分数间隔增加2分的患者被转介至精神科进行评估和治疗。
共纳入50例患者。PICS的危险因素包括操作干预次数、儿科ICU住院时间、专科会诊次数、性别、种族以及镇静/气道插管持续时间。在单因素分析中，年龄似乎是与PICS发生相关的唯一具有统计学意义的因素。与WFIRS评分变化较大相关的变量与完成的操作数量、涉及的专科医生数量以及精神科转诊需求呈统计学显著相关。远程医疗随访中仅有34%完成。
年龄与PICS的发生之间以及WFIRS评分变化与操作数量、涉及的专科医生以及精神科转诊之间存在关联。
与门诊研究相比，使用远程医疗并未提高随访率。
