Outcomes Following Admission To Paediatric Intensive Care: A Systematic Review

ABSTRACT

Introduction

Paediatric Intensive Care has developed rapidly in recent years with a dramatic increase in

survival rates. However, there are increasing concerns regarding the impact that admission to

a Paediatric Intensive Care Unit (PICU) has on both the child and their family. Following

discharge from PICU, children may be living with complex medical problems as well as

dealing with the psychosocial impact that their illness has had on them and their family.

Objectives

To describe the long-term health outcomes of children admitted to a paediatric intensive care

unit (PICU).

Methods

A full literature search was conducted including the databases; MEDLINE via PubMed,

Cochrane Central Register of Controlled Trials, (CENTRAL), Scopus, Web of Science,

CINAHL, ERIC, Health Source Nursing/Academic, APA PsycInfo. All studies including

children under 18 admitted to a PICU were included. Primary outcome was short- and longerterm

mortality. Secondary outcomes were neurodevelopment/cognition/school performance;

physical function, psychological function/behaviour impact, quality of life outcomes and

social/family implications. Studies focused on Neonatal Intensive Care Admission and

articles with no English translation were excluded.

Results

One hundred and five articles were included in the analysis. Mortality in PICU ranged from

1.3% to 50%. Mortality in high income countries reduced over time but the data did not show

the same trend for low- and middle-income countries. Higher income countries were found to

have lower Standardised Mortality Rates (SMRs) than low- and middle-income countries.

Children had an ongoing risk of death for up to 10 years following PICU admission. Children

admitted to PICU also have more ongoing morbidity than their healthy counterparts with

more cognitive/developmental problems, more functional health issues, poorer quality of life

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as well as increased psychological problems. Their parents also have an increased risk of Post

Traumatic Stress Disorder (PTSD).

Discussion

Most of the studies identified are from high income countries and only include short-term

follow up. More data is needed from low- and middle-income countries and over longer

terms. The studies were markedly heterogenous and were all observational. Agreement is

needed regarding which outcomes are most important to measure as well as standardised

methods of assessing them. Further research is needed to identify the risk factors which cause

children to have poorer outcomes as well as to identify predictive and modifiable factors

which could be targeted in practice improvement initiatives.

Key Words:Child, Children, Paediatric, Critical Care, Intensive Care, PICU, Outcomes