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Objective <p>To describe function up to 12-months after critical illness with an overall prognosis systematic review and meta-analysis.</p> Data sources <p>We searched MEDLINE, Cochrane and Embase on May 10, 2021.</p> Study selection <p>Cohorts and trials, published after 1994, in English, describing function after discharge and within 12-months of critical illness were independently assessed by two reviewers.</p> Data extraction <p>The 163 included publications described function in 15 662 children from 114 studied cohorts. Following the PRISMA guidelines, data extraction, risk of bias and GRADE assessments were independently performed by two physician reviewers. Our primary outcomes were overall, cognitive, physical, and socioemotional function after critical illness. Function was reported as raw data or categorized as normal, independent, mild to moderate impairment, moderate impairment, severe impairment, or death. Independent functioning included normal and mild to moderate impairment. Function was reported at baseline (before ICU), discharge, &lt; 6 months, 6-months, and 12-months after critical illness. Random-effects proportional meta-analyses were used to calculate proportions at specified time periods. Mixed-effects logistic regression models were used to compare function using discharge as the reference.</p> Data synthesis <p>The most frequent diagnoses were cardiac arrest (CPA) and traumatic brain injury (TBI). At discharge independent overall functioning in patients with CPA was less frequent than at baseline, and remained similar 12 months later. Compared with discharge the Odds Ratio (95% CI, <i>p</i>-value) of independent overall function at baseline was 25.3 (2.3–121, <i>p</i> = 0.007) and was 0.75 (0.43–1.33, <i>p</i> = 0.2) at 12-months with a pooled percentage (95% CI) of independent function of 22 (11- 37)% at 12 months.</p> <p>Independent overall functioning in patients with TBI improved from discharge to 12-months. Compared with discharge the Odds Ratio (95% CI, <i>p</i>-value) of independent overall function at 6&#xa0;months was 1.8 (1.4–2.4, <i>p</i> = 0.003) and was 1.6 (1.1–2.4), <i>p</i> = 0.03 at 12-months with a pooled percentage (95% CI) of independent function of 67 (53–78)% at 12 months.</p> Conclusions <p>Paediatric critical illness is associated with population-specific acquired functional impairment disability and variable recovery of function. These findings can help inform prognostication discussions and provide rationale for follow up and support programs for survivors of critical illness.</p>

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Function in the first year after paediatric critical illness- a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月22日

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  • Jessica Nicoll,
  • Christina Maratta,
  • Anab Rebecca Lehr,
  • Elizabeth Uleryk,
  • Margaret S. Herridge,
  • Unni Narayanan,
  • Eleanor Pullenayegum,
  • George Tomlinson,
  • Christopher S. Parshuram

摘要

Objective

To describe function up to 12-months after critical illness with an overall prognosis systematic review and meta-analysis.

Data sources

We searched MEDLINE, Cochrane and Embase on May 10, 2021.

Study selection

Cohorts and trials, published after 1994, in English, describing function after discharge and within 12-months of critical illness were independently assessed by two reviewers.

Data extraction

The 163 included publications described function in 15 662 children from 114 studied cohorts. Following the PRISMA guidelines, data extraction, risk of bias and GRADE assessments were independently performed by two physician reviewers. Our primary outcomes were overall, cognitive, physical, and socioemotional function after critical illness. Function was reported as raw data or categorized as normal, independent, mild to moderate impairment, moderate impairment, severe impairment, or death. Independent functioning included normal and mild to moderate impairment. Function was reported at baseline (before ICU), discharge, < 6 months, 6-months, and 12-months after critical illness. Random-effects proportional meta-analyses were used to calculate proportions at specified time periods. Mixed-effects logistic regression models were used to compare function using discharge as the reference.

Data synthesis

The most frequent diagnoses were cardiac arrest (CPA) and traumatic brain injury (TBI). At discharge independent overall functioning in patients with CPA was less frequent than at baseline, and remained similar 12 months later. Compared with discharge the Odds Ratio (95% CI, p-value) of independent overall function at baseline was 25.3 (2.3–121, p = 0.007) and was 0.75 (0.43–1.33, p = 0.2) at 12-months with a pooled percentage (95% CI) of independent function of 22 (11- 37)% at 12 months.

Independent overall functioning in patients with TBI improved from discharge to 12-months. Compared with discharge the Odds Ratio (95% CI, p-value) of independent overall function at 6 months was 1.8 (1.4–2.4, p = 0.003) and was 1.6 (1.1–2.4), p = 0.03 at 12-months with a pooled percentage (95% CI) of independent function of 67 (53–78)% at 12 months.

Conclusions

Paediatric critical illness is associated with population-specific acquired functional impairment disability and variable recovery of function. These findings can help inform prognostication discussions and provide rationale for follow up and support programs for survivors of critical illness.