Post-Intensive Care Syndrome - Pediatrics (PICS-p): Longitudinal Cohort Study

Study Overview
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Brief Summary
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Pediatric Intensive Care Unit (PICU) survival has increased substantially over the past three decades. Currently, an understanding of PICU morbidity and recovery among PICU survivors and their families is limited. Post-intensive care syndrome (PICS) consists of new or worsening impairments in physical, cognitive, or mental health status that arise and may persist after critical illness. The characteristics of PICS in children (PICS-p) are unknown. The objective of this study is to learn about pediatric recovery from critical illness to guide future intervention research to optimize child and family health.

Detailed Description
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PICS-p is a prospective longitudinal cohort study of pediatric patients experiencing 3 or more days of intensive care therapies at one of approximately 30 U.S. PICUs to evaluate child and family outcomes over two years post-PICU discharge. We will compare outcomes of these PICU patients with a control group of patients who received an overnight PICU stay but did not receive intensive care therapies, as well as with published quality of life data from the general and chronically ill populations. Children and their families will be enrolled locally from each PICU, their baseline data will be collected by local research staff, and their post-discharge outcomes will be followed centrally from the University of Pennsylvania and the Seattle Children's Research Institute. Our specific aims are to determine the physical, cognitive, emotional, and social health outcomes and trajectory of recovery in a population of children post-critical illness; to determine the baseline health, presenting problem, and PICU factors associated with impaired physical, cognitive, emotional, and social outcomes among PICU survivors; and to determine the emotional and social health outcomes in parents and siblings of PICU survivors. Our primary goal is to explicate the impact of pediatric critical illness over a two-year period of time to guide future intervention research to optimize child and family outcomes. Our overall goal is to improve the health and well-being of PICU survivors and their families.

Official Title
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Post-Intensive Care Syndrome - Pediatrics (PICS-p): Longitudinal Cohort Study

Conditions
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Critical Illness, Post Intensive Care Unit Syndrome

Participation Criteria
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Eligibility Criteria
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Case Inclusion criteria: Current admission is the child's first PICU (including pediatric subspecialty ICU) admission Patient age ≥4 weeks and ≥44 weeks corrected gestational age and <16 years (has not yet reached 16th birthday) on PICU admission At least one parent/legal guardian (≥18 years of age or considered emancipated) living with the potential subject PICU LOS of 3 days (covering at least 3 nights from midnight to 7am) in which the patient received intensive care therapies for organ dysfunction (for example, invasive mechanical ventilation, vasopressors/inotropes, acute renal replacement therapy, or other extracorporeal therapies). Anticipated patient discharge to home (directly or indirectly after a stay in another facility) Case Exclusion criteria: Patient history of neonatal intensive care unit hospitalization Life expectancy not anticipated to be more than one year (e.g., active do not resuscitate [DNR] plan or actively managed by the palliative care team for end-of-life symptom management) Patient in foster care or ward of the state Control subjects: As above but will be PICU patients who received an overnight PICU stay (<36 hours covering one midnight to 7am time period) that did not include intensive care therapies. Post-operative children who were intubated/extubated in the operating room/PACU (or intubated in the operating room and extubated in the PICU on arrival and prior to parent presence at the bedside) can be enrolled as control subjects. Control subjects will be frequency matched to cases on age group, sex, and medical complexity, that is, complex chronic disease (C-CD), noncomplex chronic disease (NC-CD), and without CD on a 2:1 case:control ratio. Family Subjects: At least one eligible parent/legal guardian must be willing to participate. In addition, up to two cognitively capable siblings (PCPC of 1 or 2) aged 8 to <16 years, who live with the patient, and who have not been ICU hospitalized will be invited to participate. If more than two siblings are eligible, the two siblings with the next birthday (regardless of birth year) will be invited to participate.

Ages Eligible for Study
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Minimum Age: 1 Month
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Case patients<br>500 patients who experience greater than or equal to 3 nights in a pediatric ICU with intensive care instrumentation. | |
| Control patients<br>250 patients who experience an overnight stay in a pediatric ICU without intensive care instrumentation. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health related quality of life (HRQOL) - Patient | PedsQL™ 4.0 Generic Core or Infant Scales (self report) | Two years | 
| Health related quality of life (HRQOL) - Parent | PedsQL™ 4.0 Generic Core or Infant Scales (parent report) | Two years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fatigue - Patient | PedsQL™ Multidimensional Fatigue Scale v3.0 (self report) | Two Years | 
| Fatigue - Parent | PedsQL™ Multidimensional Fatigue Scale v3.0 (parent report) | Two Years | 
| Sleep - Patient | PROMIS Pediatric Sleep Disturbance - Short Form 4a and Pediatric Sleep-Related Impairment - Short Form 4a (self report) | Two Years | 
| Sleep - Parent | PROMIS Sleep Disturbance - Short Form 4a and Sleep-Related Impairment - Short Form 4a (parent report) | Two Years | 
| Cognitive Functioning - Patient | PedsQL™ Cognitive Functioning Scale and Pediatric Cerebral Performance Category (PCPC) | Two Years | 
| Cognitive Functioning - Parent | PedsQL™ Cognitive Functioning Scale (parent report) and Pediatric Cerebral Performance Category (PCPC) (parent report) | Two Years | 
| Pain - Patient | PedsQL™ Pediatric Pain Questionnaire and PROMIS Pediatric Pain Interference - Short Form 8a (self report) | Two Years | 
| Post Traumatic Stress Disorder (PTSD)- Patient | Child PTSD Symptom Scale for DSM-5 (CPSS-V) (self report) | Two Years | 
| Post Traumatic Stress Disorder (PTSD)- Parent | Young Child PTSD Screen - Revised PICU (YCPS R - PICU) (parent report); PTSD Checklist for DSM-5 (PCL-5) (parent report) | Two Years | 
| Strengths and Difficulties - Patient | Strengths and Difficulties Questionnaire (SDQ) | Two Years | 
| Strengths and Difficulties - Sibling | Strengths and Difficulties Questionnaire (SDQ) | Two Years | 
| Hope - Patient | Children's Hope Scale (CHS) | Two Years | 
| Hope - Sibling | Children's Hope Scale (CHS) | Two Years | 
| Growth and Development - Patient | Survey of Well-being of Young Children (SWYC) - Milestones only (parent report) | Two Years | 
| Functional status - Patient | Functional Status Scale (FSS) and Pediatric Overall Performance Category (POPC) (parent report) | Two Years | 
| Family impact | PedsQL™ Family Impact Module v2.0 (parent report) | Two years | 
| Growth - Parent | Post-traumatic Growth Inventory - Short Form (PTGI-SF) (parent self report) | Two Years | 
| Depression - Parent | Patient Health Questionnaire-4 (PHQ-4) (parent self report) | Two years | 
| HRQOL - Sibling | PedsQL Version 4.0 Generic Core Scales (sibling self report) | Two Years | 
| Caregiving - Sibling | Multidimensional Assessment of Caring Activities (MACA-YC18) (sibling self report) | Two Years |