Outcomes of Children After Hospitalization in Intensive Care Unit

Study Overview
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Brief Summary
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More than 10,000 children are hospitalized in an PICU every year in Canada. While most of them will survive their PICU hospitalization and their critical illness, some children will not recover to their pre-illness level. Some may develop behavioral, physical, emotional or developmental problems and difficulties at school. All these problems are elements that are part of the Pediatric Post-Intensive Care Syndrome (PICS-p). It is important to understand the elements (risk factors) that play a role in the development of PICS-p. In Canada, there is no systematic follow-up for children after they leave the PICU. Understanding what can cause PICS-p (risk factors) and how much PICS-p has an impact on children and their family is very important to the family well-being.

Detailed Description
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The Pediatric Post-Intensive Care Syndrome (PICS-p) is a newly developed conceptual framework that incorporates the constellation of morbidities that are increasingly recognized to affect children and their families after a critical illness. Experts define PICS-p as a new or worsening impairment in any of the following 5 domains of child health: physical, cognitive, emotional, social, or family. In contrast to well established follow-up programs in adults, there is currently a lack of systematic follow-up of PICU survivors which prevents both the recognition and management of PICS-p. The absence of granular, empirical data on the recovery of PICU children impedes both the identification and management of PICS-p. This project is a prospective Canadian multicenter cohort study to identify risk factors of PICS-p, develop and validate a predictive model for PICS-p to detect at-risk children, characterize each domain of PICS-p over two years post critical illness and uncover additional morbidities that are not captured using the current PICS-p framework. This study will provide granular, empirical data on which to build developmentally appropriate and tailored screening, management, and intervention programs during and after PICU to improve the global recovery of critically ill children and their family.

Official Title
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After Pediatric Critical Illness (APCI)

Conditions
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Renal Disease, Liver Diseases, Heart Diseases, Trauma Injury, Sepsis, Septic Shock, Pneumonia, Bronchiolitis

Intervention / Treatment
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* Other: neurocognitive tests


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children ≤18yo hospitalized in PICU for ≥96 hours Exclusion Criteria: gestational age <37 weeks or age >18 years at PICU entry; admitted for congenital heart surgery (followed in neuro-cardiac clinics in most centers); anticipated life expectancy <1year (e.g., active do not resuscitate status).

Ages Eligible for Study
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Maximum Age: 18 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

| Intervention/Treatment |
| --- |
|Other: neurocognitive tests|Cohort study: all parents and participants will have questionnaires to complete, based on participant's age.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Identify risk factors of PICS-p at 2 months post-PICU | Identification of modifiable and non-modifiable risk factors | 2 months after PICU discharge | 
| Develop and validate a model predictive of PICS-p 2 months post PICU | The model will allow detection at PICU discharge of children in need of post-PICU follow-up | 2 months after PICU discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Uncover additional post-PICU morbidities not detected within the framework of PICS-p. | Detection of morbidities through the medical provider interview that are not included in the current framework. | Until 36 months post PICU discharge | 
| Describe the incidence of each of the five domains of PICS-p across the first two years post-PICU | Identify which domain gets impacted and when during the course of the follow-up | At 2 months, 12, 18 months and 36 months post PICU discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pediatric Intensive Care Unit, PICU