title: Adaptive behavior, functional outcomes, and quality of life outcomes of children requiring urgent ICU admission.
abstract: OBJECTIVE
  To describe the adaptive behavior and functional outcomes, and health-related quality of life of children who were urgently admitted to the ICU.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Critical Care Medicine program at a University-affiliated pediatric institution.
  
  
  METHODS
  Urgently admitted patients, aged 1 month to 18 yrs.
  
  
  METHODS
  None.
  
  
  RESULTS
  We evaluated children's adaptive behavior functioning with the Vineland Adaptive Behavior Scale-2, functional outcomes with the pediatric cerebral performance category and pediatric overall performance category, and health-related quality of life with the Pediatric Quality of Life Inventory 4 and Visual Analogue Scale. We enrolled 91 children and 65 (71%) completed the 1-month assessment. Patients had a mean (SD) Vineland Adaptive Behavior Scale-2 rating of 83.2 (± 24.8), considered to be moderate-low adaptive behavior functioning. From baseline to 1 month, pediatric cerebral performance category ratings did not significantly change (p = 0.59) and pediatric overall performance category ratings significantly improved (p = 0.03). Visual Analogue Scale ratings significantly worsened from baseline to 1 wk (p < 0.0001) and significantly improved from 1 wk to 1 month (p=0.002). At 1 month, patients had a mean (SD) Pediatric Quality of Life Inventory 4 rating of 52.8 (± 27.9) of 100, a poor quality of life rating. Circulatory admissions, worse pediatric cerebral performance category score at baseline, worse transcutaneous oxygen saturation, and longer cardiac compression duration were independently associated with worse adaptive behavior functioning. Neurological admissions, worse pediatric cerebral performance category score at baseline, longer ICU stay, and longer duration of extracorporeal membrane oxygenation were independently associated with worse functional outcome. Worse pediatric cerebral performance category score at baseline, longer ICU stay, and longer duration of extracorporeal membrane oxygenation were independently associated with worse health-related quality of life.
  
  
  CONCLUSIONS
  Children surviving PICU have significant adaptive behavior functioning and functional morbidity and reduced health-related quality of life. Although neurologic morbidity following ICU was associated with baseline state, we found that resuscitation intensity and illness severity factors were independently associated with the development of acquired brain injury and reduced quality of life.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Shanil
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Simran
authors.initials: S
authors.lastname: Singh
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Hutchison
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: Renee
authors.initials: R
authors.lastname: Sananes
authors.forename: Kerry W
authors.initials: KW
authors.lastname: Bowman
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Parshuram
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D010100:Oxygen